doctors survival guide. medical english working overseas

DOCTORS’ SURVIVAL GUIDEMedical English and Working Overseas

Sancho Rodríguez Villar & Andrew Donaldson

Dr. Sancho Rodríguez VillarIntensive Care UnitHospital Virgen de la Salud.Toledo. [email protected]

Miss Lorna GilbertEnseñanza & TraducciónPozo Amargo, 245002 Toledo. [email protected]

Dr. James ElstonSpecialist RegistrarInfectious Diseases and General Internal MedicineDepartment of Infection and Tropical MedicineCastle Hill HospitalCottingham. UK

Mr. Sunil J. AmonkarSpecialist Registrar in General SurgeryDarlington Memorial HospitalDarlington, UK

Mrs. Patricia Aparicio BravoLanguage adviserOrtega & Gasset FoundationToledo. [email protected]

Mr. Andrew DonaldsonEnseñanza & TraducciónW.S.I. Toledo, S.L.Avda de América, 145004 Toledo. [email protected]

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To my father Isidoro and my friend Dr. Kiran Gargesh (Educational Foundation), who never lose hope and still think that the world can be changed.

Sancho

To my wife, Pilar, who has always supported me in everything I do.

Andrew

If you think that you are defeated, you areIf you think that you do not dare, you shall not do itIf you think that you would like to winBut that you cannot, you shall not winBecause in the world you will fi nd thatSuccess begins with the will of man.

If you think that you will lose, you have already lostIt’s all in the mental stateBecause many races have been lostBefore they were runAnd many cowards have failedBefore having begun their workThink big and your deeds shall growThink small and you shall remain behind;You must think well to elevate yourself,It’s all in the mental state.

If you think you are ahead you areYou must think well to elevate yourselfYou must be sure of yourself,Before attempting to win a prizeThe battle of life is not always wonBy the man who is strongest or quickest,Because sooner or later the man whoWins is he who believes he can.

Dr. Christian Barnard

DOCTORS’ SURVIVAL GUIDEMedical English and Working Overseas

Contents

Introduction1. ................................................................7Finding a job2. Application forms ......................................................9C.V.’s .......................................................................... 19Cover letters ............................................................. 25Miscellaneous letters ............................................... 28Reference letters ...................................................... 29Interviews ................................................................. 31Everything you need to knowto work abroad ........................................................ 43Taking a medical history3. ........................................ 77Referral and discharge letters4. ................................ 89Clinical examination5. ............................................... 93Writing an abstract and an article6. ....................... 111Visual dictionaries7. ................................................. 129Charity work8. .......................................................... 163

7

INTRODUCTION

IntroductionThis book is intended as a guide for doctors and other healthcare

professionals who wish to work abroad to gain some experience of dif-ferent cultures and different lifestyles and for those who simply want to learn to interact with their peers around the world. It is intended as a reference book rather than a study book and comes in a handy pocket book size for use on a daily basis, much like a crutch used by physically challenged individuals.

ContentsIt provides practical examples of real situations and real issues which

doctors have to face when they want to go abroad. There are examples and advice on how to apply for and get a job, how to fi ll out application forms and write a C.V. in English and how to perform in an interview. There is advice on how to go about getting into voluntary work. There is a visual dictionary to help you learn not only medical vocabulary, but also general, everyday vocabulary as well as advice on how to write an abstract and an article for publication in medical journals.

WritersThis book was written by two professionals, one an English language

specialist and the other a doctor who had to learn everything contained in this book the hard way, by actually going to England, putting his foot in it more than once and learning from the experience, which subse-quently inspired the book that you are holding in your hand.

9

APPLICATION FORMS

10

APPLICATION FORMS

11

APPLICATION FORMS

12

APPLICATION FORMS

13

APPLICATION FORMS

14

APPLICATION FORMS

15

APPLICATION FORMS

16

APPLICATION FORMS

17

APPLICATION FORMS

18

APPLICATION FORMS

19

C.V.’S

20

C.V.’S

21

C.V.’S

22

C.V.’S

23

C.V.’S

25

COVER LETTERS

26

COVER LETTERS

27

COVER LETTERS

MISCELLANEOUS LETTERS

Dear Dr. Jones,

I am writing to you in my capacity as Guest Editor of Modern Cardiologic Review. It is my honour to be able to invite you to contribute to a special issue we are compiling on the use of technological devices in cardiovascular patients.The journal Modern Cardiologic Review is now in its seventh volume. It is indexed in many major databases, such as Chemical Abstracts, EMBASE, Scopus, EMNursing, Google, Google Scholar, Genamics and JournalSeek. The magazine´s homepage can be found at http://www. cardioreview.orgAn article on percutaneous aortic valve replacement gaining acceptance as a viable option in patients at high surgical risk would make an interesting contribution, however, you may suggest another subject or title provided it is related to the application of implantable devices in cardiovascular patients.For complete information on the format, content and instructions for authors, please visit our website http://www.benthamian.org/index.html. If you decide to submit an article, I ask that you send me the following information, within 15 days, by email to [email protected]:

The title of the article• The name of the lead author• A brief summary of the content and scientifi c objectives of the • article.

When I receive this data, I will give you more details concerning the proposed special issue of the magazine and inform you of the timelines for submission of the article, editing and publication.On submission, I would then review the article before referring it to the publisher.

Thank you very much for your cooperation.

I look forward to receiving your completed proposal.

Yours sincerely,

M.D. [email protected] EditorModern Cardiologic Review

Example of an invitation to write for a medical journal

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29

REFERENCE LETTERS

30

REFERENCE LETTERS

31

INTERVIEWS

Preparing for an interview

So, you have made it! You have sent off your C.V. and/or application form and you have impressed the hospital so much that they have set up an interview with you. Congratulations! Now it’s time for you to sit down and plan, as best you can, what you are going to say. It is almost impossi-ble to predict what questions you are going to be asked, but there are cer-tain questions which always seem to be asked in one form or another.

In this chapter we will be discussing what you should do before you go for your interview and also what to expect when you get to the inter-view itself by looking at some of the most common questions doctors are asked.

The fi rst thing you should do before you even go to the interview is get in contact with someone who already works in the department or hospital that you want to work in. We could call it ‘spying’, but we won’t. We’ll just call it ‘preparing’. Most people, when asked, will give you an opinion on what a department or another doctor is like. Calling the department in question may seem a little devious but it can also show initiative. Also, it would be a good idea to arrange a visit to the Depart-ment before the interview to get to know more about the post. Get-ting background information is key to fi nding out what the interviewers might expect from you in the way of answers.

When you fi rst get into the interview room, you are going to fi nd yourself faced with a group of people. You will be facing at least 3 but probably 4 or even more people. One of them will be the department

32

INTERVIEWS

head, another may be a representative of the personnel department and you will probably have to answer questions from 1 or 2 department con-sultants. This can be very intimidating if you have never spoken in front of a group of people before but what is the worst thing that can happen? They won’t employ you. Well, you are already in that situation, so why worry? Just get on with the job of answering their questions. Remember that you need to show that you can cope in diffi cult and stressful situa-tions. It’s all in a day’s work for most doctors, so this is your chance to shine at it.

Below, we have a list of questions that are commonly asked in inter-views. It is a good idea to think about answers to these questions and even take some time to plan out how you would respond in case you are faced with the task of answering them in person one day.

Possible Question Model AnswerWhy do you want this 1. post?

This institution is one of the leading hospitals in the country in this fi eld and I would like to be given this post because it offers an opportunity to get the best possible training in the fi eld and because there is also a high degree of practical exposure with this post.

33

INTERVIEWS

What are the qualities 2. of a good doctor?

Good doctors are people who can think on their feet. They are good team leaders as well as being good team players. Good doctors are always up to date on all medical literature and show good medical knowledge. They know how to listen to patients and other members of staff. They know how to plan ahead and are great time managers, never wasting time on useless procedures. A good doctor will know when the time has come to ask for help and will not let pride get in the way of helping a patient.

What do you expect 3. from this post?

I expect this post to help me advance toward my goal to becoming an excellent doctor. I expect this post to offer me the possibility to not only learn but to put into practice what I have been taught in my time here.

Tell us your good and 4. bad points.

There is no real answer to this one as it depends largely on what you consider to be your good points and bad points. Make sure your “bad points” are not too bad and can be construed as good points. eg. Taking work home with me, etc.

What are your short/5. medium/long term career goals?

My professional goals are to gain new skills and experience so that I can be promoted to the next level in my career as a doctor.

34

INTERVIEWS

There will always be one question which comes from the informa-tion that you supplied on your C.V. so make sure that what you say on your C.V. is the truth or that you can at least speak confi dently about things which you are supposed to know about. Nothing would be worse than writing that you spent your summer holidays bird-watching in the Himalayas and for one of the interviewers to be a avid bird watcher him-self, leaving you to admit you don’t have any idea about birds at all.........

You may also be given one or two clinical scenarios and asked to explain what you would do in each case.

Scenario 1:A colleague comes into the operating theatre prepared to oper-

ate smelling of alcohol after a very heavy night out and possibly having taken drugs. How do you face up to this situation?

Because the patient’s safety is paramount, the fi rst thing I would do would be to speak to the doctor in question. Then, I would warn the Clinical Director of the situation so a solution could be found. I would look into the possibility of rehabilita-tion for the doctor as it is a very serious situation which cannot happen in a hospital.Patients’ well-being and even their lives are at stake.

Scenario 2:You are an I.C.U. medical resident and you are awoken while

on duty to be told that one of the patients was unwell. How will you deal with this situation?

Firstly, I would ensure that there is a safe environment for myself and my colleagues to work in. Then, I would start by assessing the situation using the A (Airway), B (Breathing), C(Circulation), D(Disability) and E(Exposure) procedure so I would not miss anything. I would seek help from a senior doctor if required. Above all, I would remain calm, lead the team in a professional way and apply the qualities of a good doctor.

Some things which you should not give as reasons for applying for a position:

The salary is good. – We all know that the salary is what we are really interested in because that is what pays the bills, but it’s not good form to speak about it in a fi rst interview.

35

INTERVIEWS

The hospital is just around the corner. I couldn’t get a job at XXX hospital so I thought I would apply here instead. – You will have applied to more than one hospital but everyone wants to hear that they are the best and fi nding out they are sec-ond best is not going to put you in the interviewer’s good books.

The hospital is close to the prison where my son is staying and it will make visiting him handy. – The fact that your son, father or brother is in prison is a personal problem that has nothing to do with the hospital. I won’t have to do many on duty shifts – All doctors have to do these and although they are not popular, they are necessary. Mentioning that you are not really willing to do them before you even start is not a good idea.

Obviously, these scenarios are not the only ones that you will come across on your quest to fi nd a job. Below, we have included a long list of possible questions so you can start thinking about how you would answer them. You can sit down and try to come up with an answer for each and then practise speaking with a friend or col-league so you sound natural when you answer something similar.

General questions Tell us about yourself Talk/Walk us through your CV/Application form Speak to us about your background What is exceptional about you? What part of your CV are you most proud of?

Personal QualitiesWhy did you go into Medicine? What is your career ambition? What would you change if you could start your career again? Where exactly do you see yourself in 6-7 years? Why do you want to do this speciality in particular? What do you like about this speciality? What don’t you like about this speciality?

36

INTERVIEWS

What are the challenges facing this speciality over the next ten years? How do you know you are making the right career choice? What have you done to prepare yourself for a career in your speciality?What do you have to offer to the speciality? Give us three adjectives that best describe you. What would your friends say about you? What would your patients say about you if we asked them? What are your strengths? What are your weaknesses? What skills have you gained that will make you a good doctor? Name two skills that you would like to improve over the next two years.What skills do you need to develop most? What should we recruit you rather than any other candidate? What have you done that is different from anyone else? What makes you a good candidate for the job? How would your seniors motivate you? What do you think will be your biggest challenge in this spe- cialty?Tell us about your best consultant/colleague. Tell us about your worst consultant/colleague. What are your hobbies? How do they infl uence your medical practice?What experiences outside medicine have you found useful in your medical career?

Communication, Teamwork and Generic SkillsHow good do you consider your communication skills to be? Give us an example of a situation where your communication skills made a difference to the care of a patient.Give us an example of a situation where you failed to commu- nicate appropriately.What skills have you acquired that make you a good commu- nicator?

37

INTERVIEWS

How can you improve your communication skills? What are the attributes of a good team player? Do you work better as part of a team or alone? What is a good leader? What does leading by example mean to you? What does a good team need? What leadership skills have you acquired during your training? Tell us about your experience of managing a team of people. How do you motivate others? Describe a situation where you had to give negative feedback to somebody.Tell us about a situation where you had to bring a diffi cult person on board.Tell us about a situation where you showed leadership. Tell us about a situation where you showed initiative. What makes you angry? Have you ever been in a situation where you have had a confl ict with a colleague?Give an example of a situation where your work was criticised. How would you cope with criticism or a complaint being made against you?What is your approach to resolving confl ict? How would you handle a under-performing junior colleague? One of your SHOs says he is getting bored in his job. How do you respond?How would you handle a situation where you had a disagree- ment with a nurse over the management of a patient?What would you do if a patient disagreed with your treatment approach?How do you handle stress? How do you normally cope with pressure? How do you recognise when you are stressed? What diffi cult decisions have you made in a clinical setting?

38

INTERVIEWS

Research and AuditTell us about your research experience. How much of your research is your own design and how much was designed by your supervisor?How do you organise your research projects? Why is research important? When doing research, what is the one most important thing to get right?Do you think all trainee doctors should do research? What is Evidence Based Medicine? What are the pros and cons of Evidence Based Practice? What do you understand from the term “Research Govern- ance”?What are the different levels of evidence available? Do you think Evidence Based Medicine is applicable to all specialities?What is an audit? Tell us about your audit experience. What is the difference between audit and research? Tell us about the audit cycle. What problems are there with the way trainee doctors conduct audits?

Teaching others and keeping yourself up to dateTell us about your teaching experience. What methods of teaching do you prefer? Why? How would you convince a junior colleague of the importance of teaching?Give me an example of a situation where you recognised that a member of your team needed more training.What is Problem Based Learning? What are the pros and cons?Tell us about a case that you remember where you learnt something new.

39

INTERVIEWS

What do you do to improve your training? How do you identify your training needs? How do you keep your skills up to date? What do you get out of teaching others? What is the most interesting case you have managed? When did you last speak to your consultant? What is the biggest mistake that you have made in a clinical situation?

Ethical ProblemHow would you deal with a situation where you suspected that your consultant had a drink problem?How would you react if one of your junior colleagues came to work drunk on the ward fi rst thing in the morning? What about if it was your consultant?A patient mentions to you that on various occasions they have smelt alcohol on another doctor’s breath during clinic in the past few weeks. What do you do?How would you react if one of your female junior colleagues refused to treat a patient who is a known rapist?How would you react if a patient refused to be treated by one of your junior doctors because he is a foreigner?How do you respond if you see a patient verbally abuse a colleague?What do you do if one of you peers constantly arrives late for work in the morning?What do you do if one of your junior colleagues is placing patients at risk?Your consultant does something that goes against protocol. How you do you deal with it? How would you approach the consultant?How would you react if your consultant did not provide adequate training and adopted a condescending attitude towards you due to your apparent lack of knowledge?

40

INTERVIEWS

A patient mentions that, during an examination, one of your colleagues examined her breasts. Although the patient does not know that such behaviour was inappropriate in that context, you are. How would you respond?If you observed your consultant making inappropriate sexual remarks to one of your patients, there were no other witnesses and the consultant did not realise that you were there, how would you react?Your consultant mentions something to a patient, that you be- lieve is wrong. How do you react?You have heard rumours that one of your colleagues is taking drugs. You also know that some drugs have disappeared from the cabinet. How do you react?What do you do if one of your colleague appears to be suffering from stress?What do you do if you have suspicions that one of your colleagues has been stealing a lot of hospital property?

Clinical Governance and other IssuesWhat impact does Clinical Governance have on your daily work?Do you think Clinical Governance is useful or is it just more bureaucracy?Do you think there are any problems with the way Clinical Governance is implemented?Who is responsible for Clinical Governance at your hospital? What is Clinical Risk Management? What are Near-Miss situations? What happens to Critical Incidents Forms once they have been submitted?What is NICE? What do they do? Tell us about a NICE guideline with regards to your speciality What is the National Patient Safety Agency?

41

INTERVIEWS

What do you know about the European Working Time Direc- tive? What are its effects?What do you think about MMC? What can you tell us about appraisals? Do you feel appraisals are a useful process? What do you know about revalidation? What is the difference between appraisal and assessment? Who benefi ts most in an appraisal? What can be done to persuade the public that doctors can be trusted?Is the expanding role of nurses a benefi t or a danger to the medical profession?How do you seek informed consent for the procedures that you do?

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EVERYTHING YOU NEED TO KNOW TO WORK ABROAD


To work abroad in most countries you will require a work permit/visa. In many countries this will be acquired by the host employer. Jobs may be advertised in journals or by health departments. In some instances it may be easier to contact individual hospitals in the country in which you want to work. They may give you important information how to go about obtaining jobs/necessary paperwork/suggestions/etc even if they do not have jobs available.

ANTIGUA and BARBUDA Population: 65,000Offi cial Language: EnglishCapital: St John’s

Ministry of Health, St John’s Street, St John’s. Tel: +1 283 462 1600. Fax: 462 5003Antigua & Barbuda Medical Association: 2nd Avenue, Gambels Ter-race, PO Box 18, St John’s, Antigua. Tel: +1 283 462 1838. Fax: 462 3105The Main Hospital, Holberton Hospital, PO Box 2797, St Johns, Antigua, West Indies. Tel: +1 283 462 0251.

ARGENTINA Population: 34.6 millionLanguage: SpanishCapital: Buenos Aires

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A visa is required to enter Argentina. Contact the embassy for more de-tails. As a foreign medic you need to get your degree validated and con-tact the provincial health authorities or the Dirección de Control del Ejercicio Profesional y Establecmientos Sanitarios, Defensa 120, 5 piso, 1345. Buenos Aires, which is attached to the Ministry of Health.

Ministry of Health, 9 de Julio 1925, Buenos Aires 1332. Tel: +54 1 381 8911. Fax: 1 381 2182.Argentine Medical Association: Confederación Médica Argen-tina Av. Belgrano 1235 Buenos Aires 1093. Tel: +54 114 383 8414.www.ama-med.comArgentine Nurses Association: Federación Argentina de Enferme-ria, Avenue Rivadavia 3518, Casilla de Correo 59-Sucursal 53, CP 1204 Buenos Aires. Tel: +54 1 865 1512.Argentine Dental Association: Asociación Odontológica Argentina, Junin 959, 113 Buenos Aires. Tel: +54 11 4961 6141. Fax: 11 4961 1110 www.aoa.org.ar

AUSTRALIA Population: 19.4 millionLanguage: EnglishCapital: Canberra

For general information on Australian health care:www.health.gov.au Visas and work permits:Working holiday visas: If aged between 18 and 30 you may well be eligi-ble for a working holiday visa (417) which means you can work for three months (for a single employer) and stay in Australia for a total of a year. You can apply on-line at: www.immi.gov.au - make sure your destination is happy to employ you on a working holiday visa.Longer term work:Doctors: For work up to a year you will need a medical practitioners visa (422).

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Nurses and other health professionals: Usually a temporary residence visa can be obtained, but it depends on how much your services are needed. Sometime a Specialist (414) visa is more appropriate.

Getting Registered:Whatever your profession, you have to get registered with the ap-propriate Professional Council (coordinated by the National Of-fi ce of Overseas Skills Recognition (NOOSR) - GPO Box 1407, Canberra ACT 2601. Tel: +61 6 240 8111. Fax: 6 240 7636.www.dest.gov.au/noosr) and then get registered with the appropriate state board.

Dentists:Australian Dental Association, PO Box 520, St Leonards, NSW 1590. Tel: 02 9906 4412. Fax: 02 9906 4917. www.ada.org.au e-mail: [email protected] Australian Dental Council, Suite 1, Level 2, 112 Wellington Parade, Melbourne VIC 3002. Tel: 03 9415 1638. Fax: 03 9415 1669.Dieticians:Dietician’s Association of Australia, 1/8 Phipps Close, Deakin ACT 2600. Tel: 02 6282 9555. Fax: 02 6282 9888. www.daa.asn.au Doctors:See under “recruitment agencies” for details of Australian Medical As-sociation state divisions.Australian Medical Council, Po Box 4810 Kingston ACT 2604. Tel: 02 6270 5400. Fax: 02 62709799. www.amc.orge-mail: [email protected]:Royal College of Nursing, 1 Napier Close, Deakin ACT 2600. Tel: 02 6282 5633. Fax: 02 6282 3565. www.rcna.org.auAustralian Nursing Federation, Level 2, 21 Victoria Street, Melbourne VIC 3000. Tel: 03 9639 5211. Fax: 03 9652 0567.Australian Nursing Council Inc, 1st Floor, 20 Challis Street, Dickson ACT 2602. Tel: 02 6257 7960. Fax: 02 6257 7955. www.anci.org.au Occupational Therapists: Australian Association of Occupational Therapists: 6 Spring Street,

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Fitzroy VIC 3065. Tel: 03 9416 1021. Fax: 02 9416 1421.e-mail [email protected] Physiotherapists:Australian Physiotherapy Association, PO Box 6465, Melbourne VIC 3004. Tel: 03 9534 9400. Fax: 03 9534 9199.Radiographers:Australian Institute of Radiography, PO Box 1169, Collingwood VIC 3066. Tel: 03 9419 3336. Fax: 03 9416 0783.Speech Therapists:Speech Pathology Association of Australia, 2nd Floor, 11-19 Bank Place, Melbourne VIC 3000. Tel: 03 9642 4899. Fax: 03 9642 4922.

BELGIUM Population: 10.3 millionLanguages: Dutch, French and GermanCapital: Brussels

Ministry of Health, 33 Boulevard Bschoffshiem, Brussels B-1000. Tel: +32 220 2011. Fax: 2 220 2067.Belgian Medical Association: Association Belge des Syndicats Médi-caux, Chaussée de Boondael 6 bte 4, B-1050 Brussels. Tel: +32 644 1288. Fax: 02 644 1527.Belgian Nurses Association: Fédération Nationale Neutre des Infi rmier(ière)s de Belgique, Rue de la Source 18, B-1060 Brussels. Tel: +32 537 0193. Fax: 02 143 3453.Belgian Dental Association: Association Dentaire Belge, 40 rue Washington bte 22, B-1050, Brussels.Belgian Physiotherapy Association: Association des Kinesithera-peutes de belgique, H H enneaulaan 69, B-1930 Zavrentum. Tel: +32 725 2777. Fax: 02 725 3076.Belgian Occupational Therapy Association: Nationale Belgishe Federation von Ergotherapeuten, 87 rue de Percke, B-1180, Brussels.

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BRAZILPopulation: 161.8 millionLanguage: PortugueseCapital: Brasília

Ministry of Health: Esplanda dos Ministérios, Bloco G, 5° andar, Brasilla 70.058. Tel: +55 61 223 7340. Fax: 61 224 8747.Brazilian Medical Association: Associação Médica Brasileira, Rua São Carlos do Pinhal 324, Bela Vista Sãp Paulo SP 01333 903.www.amb.org.brBrazilian Nurses’ Association: Associação Brasileira de Enferma-gem, SGAN Av L2 Norte, Quadra 603 Módulo B, CEP 70830-30 Bra-silia DF. Tel: +55 61 226 0653. Fax: 61 225 4473.Brazilian Dental Association, Rua Thirso martins, 100, Sala 114, Sao Paulo SP 04120 050. Tel: +55 11 5574 5244. Fax: 11 5574 5244. www.abonac.org.br

CHILE Population: 14.3 millionLanguage: SpanishCapital: Santiago

Ministry of Health: Enrique Maclver 541, Santiago. Tel: +56 2 639 4001. Fax: 2 632 2405.Chile Medical Association: Colegio Médico de Chile Esmeralda 678, Casilla 639 Santiago. Tel: +56 2 633 05 05. Fax: 2 633 09 40.www.colegiomedico.clChile Nurses Association: Colegio de Enfermeras de Chile, Mira-fl ores 563, Casilla Nº 9752 Correo Plaza de Armas, Santiago, Chile. Tel: +56 2 639 8556.Chile Dental Association: Ibieta 070, Rancagua, Chile. Tel +56 72 241170. Fax: 72 236169 www.colegiodentistas.com

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COLUMBIA Population: 36 millionLanguage: SpanishCapital: Bogotá

Ministry of Health: Calle 16, No 7-39, Sante Fe de Bogotá. Tel: +57 1 282 0047. Fax: 1 282 0003.Colombian Medical Association: Federación Médica Colombiana, Calle 72 - Nº. 6-44, Piso 11 Santafé de Bogotá, D.E. Tel: +57 1 211 0208. Fax: 1 212 6082.Colombian Nurses Association: Asociación Nacional de Enfermer-as de Colombia, Carrera 27 No 46 21, Apartado Aéreo Nº 059871, Bogotá DE. Tel: +57 1 268 3535. Fax: 1 269 2095.Colombian Dental Association: Federación Odontológica Colombi-ana, Calle 71, #11-10, Piso 11, Bogotá D.E. Tel: +57 1 2556560. Fax: 2554564. www.encolombia/odontologica

CANADAPopulation: 29.5 millionLanguages: English and FrenchCapital: Ottawa

For Detailed information on visas and exam requirements, check out The Medics Guide to Work and Electives Around the World.Canadian Medical Association: Box 8650, Ottawa, On-tario K1G 0G8. Tel: 613 731 9331. Fax: 613 731 9013.Federation of Medical Licensing Associations of Canada, PO Box 8234, Ottawa, Ontario K1G 3H7. Tel: 613 738 0372.Fax: 613 738 8977.Medical Council of Canada: PO Box 8234, Station T, Ottawa, On-tario K1G 3H7. Tel: 613 521 6012. Fax: 613 521 9417. www.mcc.caCollege of Family Physicians of Canada: 2630 Skymark Avenue, Mississauga, Ontario L4W 5A4. www.cfpc.caRoyal College of Physicians and Surgeons: 774 promenade Echo

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Drove, Ottawa, Ontario K1S 5N8. Tel: 613 730 8177. Fax: 613 730 8830. www.rcpsc.medical.orgNurses:Canadian Nurses Association: 50 The Driveway, Ottawa, Ontario K2P 1E2. Tel: 613 237 2133. Fax: 613 237 3520. www.can-nurses.caDentists:Canadian Dental Association: 1815 Alta Vista Drive, Ottawa, Ontario K1G 3Y6. Tel: 613 523 1770. Fax: 613 523 7736. www.cda-adc.caRoyal College of Dentists: 365 Bloor Street East, Suite 1706, To-ronto, Ontario. Tel: 416 929 2722. Fax: 416 929 5924. www.rcdc.caNational Dental Examining Board, 100 Bronson Avenue, Suite 203, Ottawa, Ontario K1R 6G8. Tel: 613 236 5912. Fax: 613 236 8386.Physiotherapy:Canadian Physiotherapy Association: 2345 Yonge Street, Suite 410, Toronto, Ontario M4P 2E5. Tel: 416 932 1888. Fax: 416 932 9708. www.physiotherapy.caOccupational Therapists:Canadian Association of Occupational Therapists: Carleton Tech-nology and Training Centre, Suite 3400, 1125 Colonel Bay Drive, Ot-tawa, Ontario K1S 5R1. Tel: 613 523 2268. Fax: 613 523 2552.www.caot.caPharmacists: Canadian Pharmacists Association: 1785 Alta Vista Drive, Ottawa, Ontario K1G 3Y6. Tel: 613 523 7877. Fax: 613 523 0445. www.cdnpharm.ca

CHINAPopulation: 1.3 billionLanguage: mainly MandarinCapital: Beijing

The Ministry of Health, 44 Houhaibeiyan, Xicheng Qu, Beijing 100725. Tel: +86 10 403 4433.Chinese Medical Association: 42 Dongsi Xidajie Beijing 100710


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Tel: +86 10 6513 4885. Fax: 10 6512 3754.www.chinamed.org.cn - this website gives extensive details about healthcare in China and how to organize exchanges.Some Medical Schools:Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dong Dan, San Tiao, Beijing 100730. Tel: +86 10 201 7620. www.pumch.ac.cnBeijing Medical University, 38 Xue Yuan Road, Beijing, Post: 100083. Tel: +86 10 201 7620. Fax: 20 201 5681www.bjmu.edu.cn

CUBAPopulation: 11.1 millionLanguage: SpanishCapital: Havana

Ministerio de Salud Pública, Calle 23 y N, Vedado, Habana Dental Association, 23YN Vedado, Habana. Tel: +53 7 33 32 99.An extremely useful web site is www.infomed.sld.cu. This site lists a number of specialist hospitals as well as general hospitals. Instituto Superior de Ciencias Medicas de La Habana, Calle 146 y Avenida 31, Playa, Habana 11600.Tel: +53 7 218 545. Fax: +53 7 336 257. www.sld.cu/instituciones/iscmh/index.htm. This is the oldest and largest Cuban medical school using many hospitals in the area.Facultad de Ciencias Medicas Ciego de Avila, Circunvalacion y Carretera de Moron, Ciego de Avila 65100. Facultad de Ciencias Medicas Cienfuegos, Calle 51 Entre 36 y 38, Cienfuegos 55100.Facultad de Ciencias Medicas Granma “Celia Sanchez Mandu-lay”, Avenida Camilo Cienfuegas, Esquina Carretera Campechuela, Manzanillo 87510. Facultad de Ciencias Medicas Guantanamo, Calle 5 Oeste Entre 8 y 9 Norte, Guantanamo 95100.

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Facultad de Ciencias Medicas Holguin, Avenida Lenin Nº. 4 Es-quina A Aguilera, Holguin 80100. Facultad de Ciencias Medicas Las Tunas, Avenida de La Juventud s/n, Las Tunas 75100. Facultad de Ciencias Medicas Matanzas, Carretera de Quintanilla Km 101, Matanzas 40100. Facultad de Ciencias Medicas Pinar Del Rio, Carretera Central Km. 89, Pinar Del Rio 20100. Facultad de Ciencias Medicas Sancti Spiritus, Carretera Circunva-lacion Norte, Banda, Sancti Spiritus 60100. Instituto Superior de Ciencias Medicas “Carlos J. Finlay”, Car-retera Central Oeste y Madame Curie, Camaguey 70100. Tel: +53 7 989 10. Fax: +53 7 615 87. Instituto Superior de Ciencias Medicas de Santiago de Cuba, Avenida de Las Americas y Calle E, Santiago de Cuba 90100. Instituto Superior de Ciencias Medicas de Villa Clara, Carretera de Acueducto y Circunvalacion, Santa Clara 50200.

DENMARK Population: 5.4 millionLanguage: DanishCapital: Copenhagen

Ministry of Health: Herluf Trolles Gade 11, DK-1052 Copenhagen K, Denmark. Tel: +45 33 92 22 60. Fax: 33 93 15 63Danish Medical Association: Dan Almindelige Danske Laegeforen-ing, Trondhjemsgade 9, DK-2100 Copenhagen Ø. Tel: +45 35 44 85 00. Fax: 35 44 85 05. www.dadl.dkDanish Nurses Organisation: Postboks 1084, DK-1008, Copenha-gen K. Tel: +45 33 15 15 55. Fax: 33 15 24 55.Danish Dental Association: Dansk Tandlaegeforening, Amaliegade 17, DK 1256 Copenhagen K. Tel: +45 70 25 77 11. www.dtf-dk.dk Danish Physiotherapy Association: Danske Fysioterapeuter, Norre Voldgade 90, DK-1358 Copenhagen K. Tel: +45 33 13 82 11

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Fax: 33 93 82 14. www.fysio.dk Danish Occupational Therapy Association: Norre Volgade 90, DK-1358 Copenhagen K.

DOMINICAN REPUBLIC Population: 8.6 millionLanguage: SpanishCapital: Santo Domingo

Ministry of Health: San Cristoval Avenue, Santo Domingo. Tel: +809 541 3121Dominican Republic Medical Association: Asociación Médica Do-minicana, Calle Paseo de los Médicos Esquina Modesto Diaz Zona Universiteria Santo Domingo. Tel: + 809 533 4602. Fax: 535 7337.

FINLAND Population: 5 millionLanguages: Finnish and SwedishCapital: Helsinki

Ministry of Social Affairs and Health, PO Box 267, 4-6 Snell-maninkatu, Helsinki 0017.Finnish Medical Association: Suomen Lääkäriliitto PL 49, FIN 00501 Helsink. Tel: +358 90 393091. Fax: 90 3930794.Finnish Nurses Federation: Tervetden-ja sosiaalihuoltoalan ammatti-järjestä They ry, Asemamiehenkatu 4 FIN 00520 Helsinki. Tel +358 90 2290020. Fax: 90 1481840.Finnish Dental Association: Suomen Hammaslääkäriliitto, Fabi-aninkatu 9B, FIN 00130 Helsinki. Tel: +358 9 622 0250. Fax: 09 622 3050. www.hammasll.fi Finnish Association of Physiotherpists: Asemamiehenkatu 4 FIN 00520 Helsinki. Tel:+358 90 149 6817. Fax: 90 148 3054.Finnish Association of Occupational Therapists: Suomen Toimintat-

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erapeuttiliitto ry, Pautatielaisenkatu 6 FIN 00520 Helsinki Tel: +358 9 144360

FRANCE Population: 58 millionLanguage: FrenchCapital: Paris

Ministry of Social Affairs, Health and Urban Affairs, 8 Avenue de Ségur, Paris 75700 Tel: +_33 1 40 56 60 00 Fax: 1 40 56 47 92 French Medical Association: Association Médicale Française, 37 rue de Bellefond F 75441 Paris cedex 09 Tel: +33 1 45 96 34 52 Fax: 01 45 96 34 50French Nursing Association: Association Nationale Francaise des Infi rmieres et Infi rmiers Diplomes ou Itudiants (ANFIIDE), 11, Boulevard Montmartre 75002 Paris Tel: +33 1 47 36 34 60 Fax: 1 45 17 56 85 http://anfi ide.infi rmiers.com/ French Dental Association: Association Dentaire Française, 7 ue Mariotte F 75017 Paris Tel: +33 1 58 22 17 10 Fax: 01 58 22 17 40 www.adf.asso.frFrench Physiotherpay Association: Federation Française des Mas-seurs Kinesitherapeutes Reeducateurs, 24 rue des Petits Hotels F 75010 Paris Tel: +33 1 44 83 46 00 Fax: 1 44 83 46 01www.ffmkr.com French Occupational Therapy Association: Association Nationale Française des Ergothérapeutes, rue EugèOudine, F 75013 Paris Tel: +33 1 45 83 50 38 Fax: 1 45 86 81 71 www.anfe.asso.fr

GERMANY Population 81.6 millionCapital: BerlinLanguage: German

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Ministry of Health, Bonn 53108. Tel: +49 228 9410. Fax: 228 9414900German Medical Association: Bundesärztekammer, Herbert-Lewin-Strasse 1, D 50931 Cologne. Tel: +49 221 4003 209. Fax: 221 4004 380. www.bundesaerztekammer.de German Nurses Association: Deutscher Berufversband für Pfl ege-berufe, Hauptsrasse 392, D 65760 Eschborn. Tel: +49 6173 65086. Fax: 6173 61644. www.dbfk.de German Dental Association: Bundeszahnärzekammer, Postfach 410168, D 50861, Cologne. www.bzaek.de German Physiotherapy Association: Deutzer Freiheit 72-74, D 50679 Cologne. Tel: +49 221 9810270. Fax: 221 98102725.www.zvk.org German Occupational Therapy Association: Deutscher Verband der Ergotherapeuten, Postfach 2208 D 76303, Karlsbad.

INDIAPopulation: 1.03 billionOffi cial Languages: Hindi and EnglishCapital: New Delhi

Ministry of Health, Nirman Bhavan, New Delhi 110 011. Tel: +91 11 3018863. Fax: 11 3014252. www.mohfw.nic.in Medical Council of India, Temple Lane, Lotla Road, New DelhiIndian Medical Association: IMA house, IP.Marg, New Delhi-110002. Tel: +91 11 331 8819. Fax: 11 331 6270. (There are branches in every state with their own websites – do a Google search).Indian Dental Association: 20A Dewan Bahadur Road, RS Puram, Coimbatore 641 002, Tamilnadu (again, each area has its own website)All-India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India. Tel: +91 11 661123 or 11 686 45851. Fax: 11 686 26630. www.aiims.ac.in

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IRELAND Population: 3.6 millionLanguage: Irish and EnglishCapital: Dublin

Irish Medical Organisation 10 Fitzwilliam Place Dublin 2. Tel: +353 1 676 72 73. Fax: 1 661 27 58. www.imo.ieThe Medical Council, 8 Lower Hatch Street, Dublin 2Royal College of Surgeons of Ireland, 123 St. Stephen’s Green, Dublin 2. Tel: +353 1 402 2100. www.rcsi.ie email: [email protected] College of Physicians of Ireland, 6 Kildare Street, Dublin 2. Tel: 1 661 667. Fax: +353 1 676 3989. www.rcpi.ieIrish Nurses Organisation: 11 Fitzwilliam Place, Dublin 2. Tel: +353 1 676 0137. Fax: 1 661 0466. www.ino.ieIrish Dental Association: ‘Boyne’, 10 Richview Offi ce Park, Clon-skeagh Road, Dublin 14. www.dentist.ieIrish Society of Chartered Physiotherapists: Address is as Royal Col-lege of Surgeons. Tel +353 1 402 2148. Fax: 1 402 2160. www.iscp.ieAssociation of Occupational Therapists of Ireland: 29 Gardiner Place, Dublin 1. Tel: 353 1 8780247. www.aoti.ieIrish Association of Speech therapists: PO Box 1344, Dublin.

ISRAEL Population: 5.6 millionLanguage: HebrewCapital: Jerusalem

For the latest information on safety in Israel, visit: www.fco.gov.uk Ministry of Health, PO Box 1176, Ben-Tabai Street, Jerusalem 91010.Israel Medical Association: 2 Twin Towers, 35 Jabotinsky Street PO Box 3566, Ramat-Gan 52136. Tel: +972 3 610 04 44. Fax: 3 575 16 16. www.ima.org.ilIsrael Dental Association: www.ida.org.il

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ITALY Population: 58 millionLanguage: ItalianCapital: Rome

Ministry of Health, 20 Viale del’l Industria, Rome 00144. Tel: +39 6 59944. Fax: 6 964 7687.Italian Medical Association: Società Italiana di Medicina Generale, via Il Prato 66, I 50123 Firenze. www.simg.it The Italian Medical Organization: Federazione Nazionale Ordine dei Medici. www.fnomceo.itItalian Nurses Association: Consociazione Nazionale delle Associ-azioni Infermieri ed altri Operatori Sanitario-Sociali, via Arno 62, I 00198 Rome. Tel: +39 6 884 0654. www.cnai.info Italian Dental Association: Associazione Nazionale Dentisti Italiani, Via Savoia I 00198 Rome. www.andi.itItailain Physiotherapy Association: Associazione Italiana Terapisti della Rehabilitazione, Via Claterna 18 I 00183 Rome. Tel: +39 6 772 01020. www.aifi .net Italian Occupational Therapy Association: Associazione Italiana di Terapia Occupazionale, via Peralba 9, I 00141 Rome.www.aita-onlus.it

JAPAN Population: 125 millionLanguage: JapaneseCapital: Tokyo

Japan International Educational Association, 4–5–29, Komaba, Meguro-ku, Tokyo 153, Japan. Tel: +81 3 467 3521.Ministry of Education, Kasumigaseki, Chiyoda-ku, Tokyo 100, Ja-pan. Tel: +81 3 581 4211.Ministry of Foreign Affairs, 2–2–1, Kasumigaseki, Chiyoda-ku, To-kyo 100, Japan. Tel: +81 3 580 3311.

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Ministry of Health and Welfare, 1–2–2, Kasumigaseki, Chiyoda-ku, Tokyo 100, Japan. Tel: +81 3 503 1711. Fax: 3501 4853.Offi ce of National Examinations and Licences, Medical Profes-sions Division, Health Policy Bureau, Ministry of Health and Welfare, 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo, Japan 100-45. Tel: +81 3-503-1711.Japanese Medical Association: 2-28-16 Honkomagome, Bunkyo-ku, Tokyo 113. Tel: +81 3 3946 2121. Fax: 3 3946 6295. www.med.or.jp Japanese Nursing Association: 8-2, 5 Chome, Jingumae, Shibuya-ku, Tokyo 150-0001. Tel: +81 3 400 8331. Fax: 3 400 8336. www.nurse.or.jp Japanese Dental Association: 4-1-20 Kudan-kita, Chiyoda-ku, Tokyo 102-0073. Tel: +81 3 3262 9213. Fax: 3 3262 9885. www.jda.or.jp Japanese Physical Therapy Association: Health Department, School of Medicine, Hiroshima University, 1-1-89, Higashisends, Naka-ku, Hiroshima. Tel: +81 82 241 1221. Fax: 82 241 0508.www.ne.jp/asahi/jpta/international Japanese Occupational Therapy Association: 2-2-8 Nishi-Waseda, Shinjuku-ku, Tokyo 162. Tel: +81 3 3203 1286.

JORDAN Population: 5.5 millionLanguage: ArabicCapital: Amman

Ministry of Health, PO Box 86 Amman. Tel +962 6 607144.Jordan Medical Association: P.O. Box: 941070 Amman, Jordan. Fax: +962 6 5686435.Jordan Nurses and Midwives Council, PO Box 10076, Amman, Jor-dan. Tel: +962 6 689468.Jordan Dental Association: PO Box 1326, Amman 11118, Jordan. Tel: +962 6 566 5520. Fax: 6 569 6479.Jordan Physiotherapy Society: PO Box 510489, Amman 11151. Tel: +962 6 84084. Fax: 6 682299.


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There is a very useful website: www.jordandrs.com that lists all of Jor-dan’s hospitals.

KENYA Population: 29 millionLanguage: SwahiliCapital: Nairobi

Public Health Offi ce, Ministry of Health, Medical Offi cer of Health, PO Box 438 Nyambene, Kenya. www.health.go.keMedical Practitioners and Dentists Board, P O Box 44839, 00100 NAIROBI, KENYA - Physical Address: MP & DB House,Woodlands Rd, Off Lenana Rd, Opposite Chinese Embassy. Tel No: 254 2724994/2728752/2711478. Fax: 254 2724938. Email: [email protected] Website: www.medicalboard.co.keKenya Medical Association, Chyulu Road, Upper Hill P.O. Box 48502. Nairobi. Tel. +254 2 714991.Kenya Dental Association: PO Box 20059, Nairobi. Tel: +254 2 544542.Kenya Nurses Association: Tel. +254 2 229083.

MEXICOPopulation: 94 millionLanguage: SpanishCapital: Mexico City

The International Relations Department of the Health Ministry: Secretaría de Salud, Dirección General de Asuntis se Asuntos Inter-nacionales, Dr Rafael Alvarez Cordero, Director General, Francisco P Miranda No 177–4o piso 06100 Mexico, DF. Tel: +52 5 651 0828. Fax: 5 583 0833 www.ssa.gob.mxMexican Medical Association: Asociación Nacional de Colegios, Médicos Estatales Rosalio Bustamante Nº 224, Col. Esfuerzo nacional,

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CD, Madero, Tams. CP 89470. Tel: +52 12 17 03 88. Fax: 12 13 19 69Mexican Nurses Association: Colegio nacional de Enfermeras AC, Czda Obrero Mundial 229, Cal del Valle, Apartado Postal 12-986, 03100 México DF. Tel: +52 5 543 6637. Fax: 5 669 4031Mexican Dental Associtaion: Asociación Dental Mexicana AC, Ezequiel Montes Nº 92, Col. Revolución, Delegación Cuahternoc, mexico 06030 DF. Tel: +52 555666133.

NAMIBIA Population: 1.5 millionLanguage: EnglishCapital: Windhoek

Ministry of Health, Old State Hospital, Harvey Streetm Pri-vate Bag 13198 Windhoek. Tel: +264 61 20391111. Fax: 61 227607

NETHERLANDSPopulation: 15.5 millionLanguage: DutchCapital: Amsterdam

Ministry of Health, Welfare and Sports, PO Box 5406, 2280 HK Rijswijk. Tel: +31 340 7911. Fax: 340 7834.Royal Dutch Medical Association: Postbus 20051 NL 2501 LB Utrecht. Tel: +31 30 823326. www.knmg.nl Dutch Nurses Association: Nieuwe Unie ’91, Leideseweg 83, Post-bus 6001, NL 3503 PA Utrecht. Tel: +31 30 964144. Fax: 030 963 904. www.nu91.nl Dutch Dental Association: Nederlandsche Maatschappij tot Bev-ordering der Tandheelkunde, Geelgors 1, Postbus 2000 NL-3430 CA Nieuwegein. Tel: +31 30 6076276. Fax: 030 604 8994. www.nmt.nl

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Dutch Physiotherapy Association: Koninklijk Nederlands Genoot-schap Fysiotherapie, Postbus 248, NL 3800 AE Amersfoort, Van Ho-gendorplan 8. Tel: +31 33 467 2900. Fax: 033 467 2999. www.kngf.nl Dutch Association of Occupational Therapists: Nederlandse Vereniging van Ergotherapie, Kaap Hoorndreef 48B, NL 3536 AV Utrecht. www.ergotherapie.nl

NEW ZEALAND Population: 3.6 millionLanguage: EnglishCapital: Wellington

Visas and work permits:Visit: www.immigration.govt.nz. Dentists:New Zealand Dental Association, PO Box 28 084, Auckland 5. Tel: 09 524 2778. Fax: 09 520 5256. www.nzda.org.nz e-mail: [email protected] Zealand Dental Therapists Association, 9 Miriam Corban Heights, Henderson, Auckland www.nzdta.co.nz Dental Council of New Zealand, Level 8, 108 The Terrace, PO Box 10-448, Wellington. Tel: 04 499 1668. www.dentalcouncil.org.nz Dieticians:New Zealand Dietetic Association, PO Box 5065, Wellington.Tel: 04 473 3061. Fax: 04 473 3062. www.dietitians.org.nze-mail: [email protected] Dieticians Board, PO Box 10-140, Wellington. Tel: 04 499 7979.Fax: 04 472 2350.Doctors:New Zealand Medical Association, PO Box 156, Wellington. Tel: 04 472 4741. Fax: 04 471 0838. www.nzma.org.nz The Medical Council of New Zealand, 139-143 Willis Street, PO Box 11-649, Wellington. Tel: 04 384 7635. Fax: 04 385 8902. www.mcnz.org.nz

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Nurses: Nursing Council of New Zealand, PO Box 105 483, Aucklandwww.nursingcouncil.org.nzNew Zealand Nurses Organization, PO Box 2128, Wellington.Tel: 04 386 0847. Fax: 04 382 9993. www.nzno.org.nzNurses Association Inc, PO Box 2128, Wellington www.nram.org.nz Occupational Therapists: New Zealand Association of Occupational Therapists, PO Box 12-506, Royal Society of New Zealand Offi ces, 4 Halswell Street, Thorndon, Wellington 6001. Tel: 04 473 6510. Fax: 04 473 1841.www.nzaot.com Occupational Therapy Board, PO Box 10-140, Wellington.Tel: 04 499 7979. Fax: 04 472 2350.www.occupationaltherapyboard.org.nz Pharmacists:Pharmacy Guild of New Zealand, PO Box 27139, 124 Dixon Street, Wellington. Tel: 04 802 8200. Fax: 04 384 8055. www.pgnz.org.nz e-mail: [email protected] Physiotherapists:New Zealand Society of Physiotherapists, PO Box 27 386, Level 5, Wang House, 195-201 Willis Street, Wellington. Tel: 04 801 6500.Fax: 04 801 5571. www.physiotherapy.org.nze-mail: [email protected] Board, PO Box 10 734, Wellington. Tel: 04 471 2610. Fax: 04 471 2613. www.physioboard.org.nz e-mail: [email protected] Therapists:New Zealand Speech-Language Therapists Association, Suite 369, 63 Remuera Road, Newmarket, Auckland. Tel: 03 235 8257. Fax: 03 235 8850 www.nzsta-speech.org.nz e-mail: [email protected]

NORWAYPopulation: 4.5 millionLanguage: NorwegianCapital: Oslo

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Ministry of Health, PO Box 8011 Dep, 10 Grubbegt, Oslo 0030.Tel: +47 22 24 90 90. Fax: 22 24 9575.Norwegian Medical Association: Norske Laegeforening, Postboks 1152 sentrum N 0107 Oslo. Tel: +47 23 10 90 00. Fax: 23 10 90 10.www.legeforeningen.no Norwegian Nurses Association: Norsk Sykepleierforbund, Boks 2633, St Hanshaugen N 0131 Oslo. Tel: +47 22 04 33 04.Fax: 22 71 60 96. Norwegian Dental Association: Norske Tannlaegeforening, Fred-erik Stangs gt 20, N 0264 Oslo. Tel: +47 22 54 74 00. Fax: 22 55 11 09 www.tannlegeforeningen.no Norwegian Association of Physiotherapists: Norske Fysioter-apeutes Forbund, Postboks 7009, Majorstua N 0306 Oslo.Tel: +47 22 69 78 00. Fax: 22 56 58 25.Norwegian Association of Occupational Therapists: Norsk Er-goterapeut Forbund, Lakkegaten 19-21 N 0187 Oslo.

PARAGUAYPopulation: 5 millionLanguages: Spanish and GuaraníCapital: Asunción

The Ministry of Health, Ministerio de Salud Publica y Bienestar So-cial, Av Pettirossi y Brasil, Asunción, Paraguay. Tel: 21 207 328.Fax: 21 206 700.Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Casilla de Correo No 1102, Avenida Dr Montero 658, Asunción, Para-guay. Tel: +595 21 481 549. Fax: 21 480 130. www.una.py (Founded 1898.)

PERU Population: 24 millionLanguages: Spanish, Quechua and AymaráCapital: Lima

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Visas and Work Permits: Nationals of some countries, including the UK, Australia, NZ, USA and most of Europe can stay for 90 days without a permit. They are required to have a return ticket. British volunteer workers should obtain a visa either before they go or once in Peru. Student visas can easily be obtained with a letter from the institu-tion in Peru, a couple of photos, your passport and a copy of your last bank statement. To work for payment, the institution has to apply to their department of immigration. If working for a charity, their spon-sors must apply to the Secretaria Ejecutiva de Coperacion Técnica International of the Ministerio de la Presidencia. The Peruvian Immigration Service can then authorize a visa. Alternatively, you can go out as a tourist and apply for a visa when you are there. The Em-bassy can provide a list of clinics and hospitals across Peru.Ministry of Health: Ministry de Salud 8 Cuadra Avda Salaverry, Jesús Maria, Lima 11 Tel: +51 1 4326242 Fax: 1 4313671Peru Medical Association: Colegio Médico del Perú Malecón Ar-mendáriz No. 791 Mirafl ores Lima. Tel: +51 1 447 49 30. Fax: 1 242 39 17. www.colmed.org.pePeru Dental Association: Los Proceres 261, Urb Santa Constanza, Surco. Tel: +51 1 435 1623. Fax: 1 435 1623.

PORTUGALPopulation: 11 millionLanguage: PortugueseCapital: Lisbon

General Medical Council (Ordem dos Medicos de Portugal): Av. Almirante Gago Countinho, 151. 1749-84. Lisboa. Tel (00351) 218427100. Fax(00351) 218427101.https://www.ordemdosmedicos.pt/Ministerio Da Saude: Departamento de Recursos Humanos.Av. Miguel Bombarda, 6.1000-208. Lisboa. Tel.(00351) 217935427.Fax.(00351)217960415

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RUSSIAPopulation: 150 millionLanguage: RussianCapital: Moscow

Ministry of Health, 8 Rakhmanovsky per, Moscow 101431.Tel: +7 95 923 84 06. Fax: 95 292 41 53.Russian Dental Association: Offi ce 202, 34 Novly Arbat Str, Mos-cow 121099. Tel: +7 095 205 03 40. Fax: 095 205 03 40.Some Medical Schools:Arkhangelsk : Arkhangelsk State Medical Academy www.asma.ruBarnaul: Altai State Medical University www.medlink.ru/asmu/Blagovestchensk: Amur State Medical Academy.www.amursu.ru:8101Chelyabinsk: Chelyabinsk State Medical Academy, Institute of Medical Education www.vita.chel.suIvanovo: Ivanovo State Medical Academy www.isma.indi.ruMoscow:I.M. Sechenov Moscow Medical Academy www.mma.ruJewish State Academy (Moscow), Faculty of Medicine Ulica B. Bronnaja 6, Moscow 103104. Tel: +7 95 122 3336.People’s Friendship University of Russia, Faculty of Medicine www.med.pfu.edu.ruRussian State Medical University (RSMU),Medical Faculty www.chat.ru/~ussrgmu Moscow State University (M.V. Lomonosov). West Siberia: Siberian State Medical University.www.ssmu.ru/ofi ce/kaf/mo.htmlSmolensk: Smolensk State Medical Academy.www.smolensk.ru/user/sgmaTyumen: Tyumen State Medical Academy (TSMA).www.tsu.tmn.ruEkaterinburg: Ural State Medical Academy www.usma.ruVolograd: Volgograd State Medical Academy.www.avtlg.ru/~vlgmed

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SAUDI ARABIA (KINGDOM OF)Population: 17 millionLanguage: ArabicCapital: Riyadh

For up-to-date security information, check: www.fco.gov.uk Ministry of Health, Airport Road, Riyadh 11176.Tel: +966 1 401 5555. Fax: 1 402 9876.Some Medical Schools:King Abdul Aziz University, Faculty of Medicine and Allied Health Sciences, Department of Medicine, P.O. Box 1540, Jeddah 21441.Tel: +966 2 6952035. Fax: 2 640 0855. www.kaau.edu.sa King Faisal University, College of Medicine P.O. Box 2114, Dam-mam 31451. Tel: +966 3 857 5307. Fax: 3 857 5329. www.kfu.edu.saThis is an special country in which to work. In order to work as a doctor, you may contact one of the international recruitment agencies available. Here is an agency contact:Dr. Sulaiman Al Habib Medical GroupConsultants in All Specialties:Western Qualifi cation such as: American Board Certifi cation; Membership/Fellowship of UK/Ireland/Canada;FACHARTZ or equivalent; having at least4 years postgraduate experience.Our remuneration package offers the following benefi ts:* Competitive Salary (TAX FREE) * Bonus 1/2 Salary/yearly’* Free Child Education * Medical Facilities* Free Malpractice Ins. * CME* Special Incentive Scheme * and other benefi ts* Free Housing (Furnished Family Accommodation)Applicants may submit their comprehensive CVs at:Fax No.: +966-1-4646136, www.drsulaimanalhabib.comEmail: [email protected]

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SOUTH AFRICA Population: 43 millionLanguages: English, Afrikaans and nine separate African languagesCapitals: Pretoria, Cape Town and Bloemfontein.

Department of Health, Hallmark Building, Proes St, Pretoria 0002. Tel: +27 12 312 0000.South African Medical and Dental Council, PO Box 205, Pretoria 0001. Tel: +27 12 328 6680. Fax: 12 328 5120.South African Medical Association, PO Box 74789, Lynnwood Ridge 0040, Castle Walk Offi ce Park, Block F, Nossob Street, Erasmuskloof Ext 3, Pretoria 0153. Tel: +27 12 481 2000. Fax: 12 481 2100.www.samedical.org South African Nursing Association: PO Box 1280, Pretoria 0001.Tel: +27 12 343 2315. Fax: +12 344 0750.South African Nursing Council: PO Box 1123, Pretoria 0001 Tel: +27 12 343 0121 Fax: 12 343 5400South African Dental Association, 31 Princess of Wales terrace, Parktown, Gautang. Tel: +27 11 484 5288. Fax: 11 642 5718.www.sadanet.co.zaSouth African Society of Physiotherapists: PO Box 92125, Nor-wood 2117. Tel: +27 11 485 1467. Fax: 11 485 1613. South African Occupational Therapy Association: 946 Shoeman Street, Arcadia 0083. www.linx.za.occther

SPAIN Population: 40 millionLanguages: Spanish, Galician, Basque and CatalonianCapital: Madrid

Ministry of Health: Ministerio de Sanidad y Consumo, Paseo del Prado 18–20, 28071 Madrid. Spain. Tel: +34 1 596 1000.Fax: +34 1 596 1547Spanish Medical Association: Consejo General de Colegios Ofi ciales

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de Médicos, Villanueva 11, Madrid 28001. Tel: +34 91 431 77 80.Fax: 91 576 43 88.Spanish Nurses Association: Organización Colegial de Enfermería, Consejo general, c/Don Ramón de la Cruz 67 E. 28001 Madrid.Tel: +34 91 401 1200. Fax: 91 309 3049.Spanish Dental Association: Alcalá, 79-2, Madrid 28009 .Tel: +34 91 426 4410. Fax: 91 577 0639. e-mail: [email protected] Spanish Physiotherapy Association: Asociacion Espanola de Fisiot-erapeutas, Conde de Penalver, 38-2, E. 28006 Madrid.Tel: +34 91 4011136. Fax: 91 4012749.Spanish Occupational therapy Association: Asociacion Profession-al Espanola de terapia Ocupacional, c/o Modesto Lafuente 63 3C, E. 28002 Madrid

SWAZILANDPopulation: 900,000Languages: Siswati and EnglishCapital: Mbabane

Ministry of Health: PO Box 5, Mbabane. Tel: +268 42431.Fax: 42092.Swaziland Dental Association, PO Box 1291, Matsapha.

SWEDEN Population: 8.8 millionLanguage: SwedishCapital: Stockholm

Ministry of Health: 26 Jakobsgt, Stockholm 103 33.Tel: +46 8 405 1000. Fax: 8 723 11 91.Swedish Medical Association Sveriges Läkarförbund Villagatan 5 P.O. Box 5610 11486 Stockholm. Tel: +46 8 790 33 00.Fax: 8 20 57 18. www.slf.se

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Swedish Nurses Association: Östermalmsgatan 19 S-114 26 Stckholm. Tel: +46 8 412 24 00. Fax: 8 412 24 24. www.swenurse.se NB There is a Swedish Association of Trauma Nurses: www.trauma.c.se Swedish Dental Association: Svierges Tandläkarförbund Box 5843, S 10248, Stckholm. Tel: +46 8 666 1500. Fax: 8 662 5842. www.tandlakarforbundet.se Swedish Physiotherapy Association: Legitimerade Sjukgymnasters Riksförbund, PO Box 3196 S 10363, Stckholm. Tel +46 8 696 97 45. Fax: +46 8 696 97 54.. www.lsr.se Swedish Occupational Therapy Association: PO Box 760 S 13124 Nacka.

TURKEYPopulation: 62 millionLanguage: TurkishCapital: Ankara

Ministry of Health, Saglik Bakanligi, Yenisehir, Ankara.Tel: +90 312 4312486. Fax: 312 4339885Turkish Medical Association: GMK Bulvari Sehit Danis Tunaligil Sok. Nº:2 Kat: 4, 06570 Maltepe Ankara. Tel:+90 312 231 3179.Fax: 312 231 1952Turkish Dental Association, Ziya Gökalp Caddesi Bo:37/11, Kizilay, Ankara 06410. Tel: +90 312 435 93 94. Fax: +90 312 430 29 59

UGANDA Population: 22 millionLanguage: EnglishCapital: Kampala

www.health.go.ug is a fantastic site with full lists of hospitals and other health facilities and information on AIDS, child health programmes, public health programmes, and disease surveillance.

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Ministry of Health, PO Box 8, Entebbe Tel: +256 42 20201Uganda Medical Council, PO Box 16115, Wandegeya, KampalaUganda Medical Association, Plot 8, Katonga Road P.O. Box 2243, Kampala. Tel. +256 41 236 539. Fax. 41 532 591.

UNITED KINGDOM Population: 58 millionLanguage: EnglishCapital: London

Over the next few years, the General Medical Council will be changing the way doctors within the UK are regulated to practise medicine.On 16 November 2009 the GMC introduced the licence to practice. To practise medicine in the UK all doctors are required by law to hold both registration and a licence to practise.http://www.gmc-uk.org/doctors/licensing/[email protected]

Professional and Linguistic Assessments Board (PLAB)The PLAB test is the main route by which International Medical Graduates (IMGs) demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

http://www.gmc-uk.org/doctors/plab/before_you_apply.asphttp://www.gmc-uk.org/doctors/plab/advice_part1.asphttp://www.gmc-uk.org/doctors/plab/advice_part2.asp

Postgraduate education

In the UK doctors provisionally registered with a licence to practise spend the fi rst year after graduating from medical school training in a programme for provisionally registered doctors. This is the fi rst year of the two-year Foundation Programme.The GMC is responsible for doctors in the fi rst year of the Foundation Programme, which is called F1.

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Our guidance for this period is called The New Doctor. This sets out the standards that Foundation Programme providers must meet, and the outcomes that F1 doctors must demonstrate before they are eligible to apply for full registration with a licence to practise.An organisation called PMETB is responsible for the second year of the Foundation Programme, which is called F2.After completing a medical degree and foundation training, many doctors complete a third stage to become general practitioners or consultants. http://www.gmc-uk.org/education/postgraduate/regulation.asphttp://www.gmc-uk.org/education/postgraduate/postgraduate_training.aspFor Doctors:The Department of Health: Richmond House, 79 Whitehall London SW1A 2NS. Tel: +44 207 210 4850. www.doh.gov.uk British Medical Association BMA House, Tavistock Square, London WC1H 9LP. Tel: 020 7383 6177. Fax: 020 7383 6220. www.bma.org.uk General Medical Council: 44 Hallam Street, London W1N 6AE.Tel: 7580 7642. Fax: 7915 3641. www.gmc-uk.orgRoyal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ. Tel: 0131 225 7324. Fax: 0131 225 2053. www.rcpe.ac.uk Royal College of Surgeons of Edinburgh, Nicholson Street, Edinburgh EH8 9DW. Tel: 0131 527 1600. Fax: 0131 557 646. www.rcsed.ac.uk Royal College of Physicians and Surgeons of Glasgow, 242 St Vin-cent Street, Glasgow G2 5RJ. Tel: 0141 221 6072. Fax: 0141 248 3414. www.rcpsglasg.ac.uk Royal College of Physicians of London, 11 St Andrew Place, Re-gent’s Park, London NW1 4LE. Tel: 020 7935 1174. Fax: 020 7486 4514. www.rcplondon.ac.uk Royal College of Surgeons of England, 35/43 Lincoln’s Inn Fields, London WC2A 3PN.Tel: 020 7405 3474. Fax: 020 7973 2179. www.rcseng.ac.uk Royal College of Anaesthetists, 48049 Russell Square, London WC1B 4JY. www.rcoa.ac.uk Royal College of Obstetricians and Gynaecologists, 27 Sussex Place,

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Regents Park, London NW1 4RG. Tel: 020 7772 6263.Fax: 020 7772 6359. www.rcog.org.ukRoyal College of Ophthalmologists: 17 Cornwall terrace, Regents Park, Lonson NW1 4QW. Tel: 020 7935 0702. Fax: 020 7935 9838.www.rcophth.ac.ukRoyal College of Pathologists: 2 Carlton House Terrace, London SW1Y 5AF. Tel: 020 7930 5863. Fax: 020 7321 0523. www.rcpath.org Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351. Fax: 020 7245 1231. www.rcpsych.ac.uk Royal College of Radiologists, 38 Portland Place, London W1N 4JQ. Tel: 020 7636 4432. Fax: 020 7323 3100. www.rcr.ac.uk Northern Ireland Council for Postgraduate Medical Education, 5 Annadale Avenue, Belfast BT7 3JH. Tel: 01232 491731.Fax: 01232 642279.For Nurses:Royal College of Nursing: 20 Cavendish Square, London W1M 0AB Tel: 020 7409 3333. Fax: 020 7355 1379. www.rcn.org For Dentists:British Dental Association, 64 Wimploe Street, London W1M 8AL Tel: 020 7935 0875. Fax: 020 7487 5232. www.bda-dentistry.org.ukGeneral Dental Council: 37 Wimpole Street, London W1M 8DQ.Tel: 020 7887 3800. Fax: 020 7224 3294. www.gdc-uk.orgFor Speech and Language Therapists:Royal College of Speech and Language Therapists: 2/3 White Hart Yard, London SE1 1NX. Tel: 020 7378 1200. Fax: 020 7403 7254. www.rcslt.org For Physiotherapists:Chartered Society of Physiotherapy, 14 Bedford Row, London WC1R 4ED. Tel: 020 7306 6666.Fax: 020 7306 6611.For Occupational Therapists:British Association of Occupational Therapists: 6-8 Marchasea Road, London SE1 1HL. Tel: 020 7357 6480. Fax: 020 7378 1353.Midwives:Royal College of Midwives: 15 Mansfi eld Street, London W1M 0BE Tel: 020 7312 3535. Fax: 020 7312 3536. www.rcm.org.uk

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Pharmacists:Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London SE1 1NX. Tel: 020 7735 9141. Fax: 020 7735 7629.www.rpsgb.org.ukRadiographers:Society of Radiographers, 2 Carriage Row, 183 Eversholt Street, London NW1 1BU. Tel: 020 7391 4500. Fax: 020 7391 4504.

USAPopulation: 274 millionLanguage: EnglishCapital: Washington DC

As a doctorIf you want to work in America, then the main problem is not getting in, but getting exams done in order to obtain licensure. The following are needed before you apply for a work permit:

You must pass the United States Medical Licensing Exami- nations (USMLE www.usmle.org) (three steps, see below). Pass an English Language Profi ciency test Pass a Clinical Skills Assessment You need all the appropriate documents from your country

stating that you can practice medicine unrestricted The Educational Commission for Foreign Medical

Graduates (ECFMG) will also need to confi rm your medical credentials with your medical school. http://www.ecfmg.org/

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation of post-MD medical training programs within the United States. Accreditation is accom-plished through a peer review process and is based upon established standards and guidelines.http://www.acgme.org/acWebsite/home/home.asp

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The National Resident Matching Program (NRMP) is a private, non-profi t-making corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education (GME) in the United States. http://www.nrmp.org/

The USMLE itself does not give licensure, but the results are given to the appropriate state medical board who can then grant such licenses. Step one concerns basic biomedical science with emphasis on principles and mechanisms of health, disease and modes of therapy. Step two assesses the application of your medical knowledge to clinical science, including health promotion and disease prevention. Step three assesses how you combine your knowledge of biomedical science and clinical medicine to unsupervised patient care. All steps should be completed within seven years. A number of medical students are now doing the USMLE exams whilst doing their undergraduate course (steps one and two can be done before qualifi cation). This has the obvious advantage that it’s all fresh in your mind. If you haven’t done them, don’t panic. There are excel-lent revision courses available specifi cally for them. A good time to con-sider doing them is after MRCP/MRCS, but you will also need to revise pre-clinical medicine and all the specialities, including paeds, psychiatry etc. For detailed information contact: the Educational Commission for Foreign Medical Graduates, 3624 Market Street, Philadelphia, PA 19104 USA. Tel: 215 386 5900 or visit:www.usmle.org or www.ecfmg.org

Contact the Embassy for information regarding work permits, but by far the biggest hurdle is getting licensed. This licensing makes short-term work opportunities near impossible, although there are plenty of research opportunities since no license is needed for this.As a nurseNurses need to have passed the state licensing exam (the National Council of State Boards of Nursing Licensure Examinations (NCLEX) but before you can do this you will have to sit the Commission on Graduates of Foreign Nursing Schools (CGFNS) exam. This CGFNS exam is required before you can get an H1-A Nurses visa.

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Professional Organisations:Doctors:American Medical Association: 515 North State Street, Chicago, Il-linois 60610 Tel: 312 464 4677 Fax: 312 464 4567 www.ama-assn.orgFederation of State Medical Boards: Federation Place, 400 Fuller Wiser Road, Suite 300, Euless. TX 76039-3855. Tel: 817 868 4000.Fax: 817 868 4098. www.fsmb.orgEducational Commission for Foreign Medical Graduates (ECFMG): 3624 Market Street, Philadelphia, Pennsylvania 19104 2685. Tel: 215 386 5900. Fax: 215 387 9963.Family Practitioners: American Academy of Family Physicians, 11400 Tomahawk Creek Parkway Leawood, KS 66211-2672. Tel: 800-274-2237. www.aafp.orgbPhysicians: American College of Physicians: 190 N Independence Mall West, Philadelphia, PA 19106-1572. Tel: 800-523-1546.www.acponline.orgObstetrics and Gynaecology: American College of Obstetricians and Gynaecologists: 409 12th St., S.W., PO Box 96920 Washington, D.C. 20090-6920. www.acog.orgRadiology: American College of Radiologisy: 1891 Preston White Drive, Reston, Virginia 22091. Tel: 703 648 8900. www.acr.orgSurgeons: American College of Surgeons: 633 North Saint Clair Street, Chicago, IL 60611-3211. Tel: 312 202 5000. Fax: 312 202 5001. www.facs.orgNurses:American Nurses Association Inc: 600 Maryland Avenue, SW, Suite 100 West, Washington DC 20024. Tel: 202 651 7134. Fax: 202 651 7001. www.ana.orgAmerican Association of Colleges of Nursing: One Dupont Cir-cle, NW Suite 530 Washington DC20036. Tel: 202 463 6930. Fax: 202 785 8320 www.aacn.nche.eduCommission on Graduates of Foreign Nursing Schools (CGF-NS): 3600 Market Street, Suite 400, Philadelphia, Pennsylvania 19104-2651. Tel: 215 349 8767. Fax: 215 222 8454 www.cgfns.orgNational Council of Sate Boards of Nursing: 676 N St Clair Street,

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Suite 550, Chicago, Illinois 60611-2921. Tel: 312 787 6555.www.ncsbn.org Dentists: American Dental Association: 211 East Chicago Avenue, Chicago IL 60611. Tel: 312 440 2500. Fax: 312 440 2800. www.ada.orgPhysiotherapists:American Physical Therapy Association: 111 North Fairfax Street, Alexandria, Virginia 22314. Tel: 703 684 2782. Fax: 703 684 7343.www.apta.orgFederation of State Boards of Physical Therapy: 509 Wythe Street, Al-exandria, VA 22314. Tel: 703 299 3100. Fax: 703 229 3110.www.fsbpt.orgOccupational Therapists:American Occupational Therapy Association Inc: 4720 Mont-gomery Lane, PO Box 31220, Bethesda, Maryland 20824-1220.Tel: 301 652 2682. Fax: 301 652 7711. www.aota.orgNational Board for Certifi cation in Occupational Therapy: 800 S Frederick Avenue, Suite 200, Gaithersburg, Maryland 20877-4150.Tel: 301 990 7979. Fax: 301 869 8492.

VENEZUELA Population: 22 millionLanguage: SpanishCapital: Caracas

Ministry of Health: Torre Sur, 5°, Centro Simón Bolivar, Caracas 1010. Tel: +58 2 483 3533.Venezuela Dental Association: Avenida Guanare, Urb Las Palmas, Edif. COV Piso 3, Apartado de Correos 1341, Caracas. Tel: +58 2 793 6604. Fax: 2 793 7494.Some Medical Schools:Anzoátegui:Universidad de Oriente (Núcleo Anzoátegui)Escuela de Medicina, Carretera Negra vía el Tigre, Ave. Universidad, Puerto La Cruz, Estado Anzoátegui. Tel: +58 281 262 331.Fax: 281 268 1533. www.anz.udo.edu.ve

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Bolívar:Universidad de Oriente (Núcleo Bolívar)Escuela de Medicina, Calle Raúl Leoní con Calle Columbo Silva, Ciu-dad Bolívar, Edo. Bolívar. Tel: +58 285 223 738. Fax: 285 285 226.www.re.udo.edu.veCaracas:Universidad Central de VenezuelaEscuela de Medicina “José María Vargas”, Ciudad Universitaria, Cara-cas, Distrito Federal. Tel: +58 2 606 7770. Fax: 2 605 3522.www.med.ucv.veUniversidad Central de VenezuelaEscuela de Medicina “Luis Razetti”, Edif. Decanato de Medicina, Urb. Los Chaguaramos, Caracas, Distrito Federal. Tel: +58 2 605 3347.Fax: 2 605 3520. www.med.ucv.ve

ZAMBIA Population: 9.8 millionLanguages: English, Bemba and NyanjaCapital: Lusaka

Medical Council of Zambia, Dental Training School Premises, PO Box 32554, Thornpak, 10101 Lusaka.Zambia Medical Association, PO Box 50903, Lusaka.Zambia Dental Association, PO Box 50 363, Lusaka 15101.Tel: +260 1 221 257. Fax: +260 1 263 401.

ZIMBABWE Population: 11.3 millionLanguage: EnglishCapital: Harare

Check www.fco.gov.uk for the latest advice on the stability/safety situ-ation in Zimbabwe.Health Professions Council, PO Box A 480, Avondale, Harare.Zimbabwe Medical Association, PO Box 3671, Harare.Tel: +163 4 73 54 01. Fax: 4 72 07 31.

77

TAKING A MEDICAL HISTORY

History taking is an essential skill which doctors need to be able to do well. It is necessary to be fl exible as well as methodical and systematic in approach. Each doctor will do it in a different way as there is no correct way to do it. The history is the patient’s account of the problem. Below, you can see an effective way of getting all the important information in a logical way, systematic way:

Introduction andpatient’s details

Presenting complaint andhistory of the presenting complaint

Past medical and surgical history

Medications, drughistory, and allergies

Smoking and alcohol history

Social, occupational,and family history

Systems review (inquiry)

Conclusion and closure

Coping with illness

How the illness has affectedthe psyche, personal life,

family, fi nances, andoccupation

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Important tips:-Welcome in a warm, friendly manner-Maintain good eye contact-Make physical contact as appropriate-Listen attentively-Avoid being judgemental

1- Personal details.

You should always begin by introducing yourself. This should include your status as well as the educational reason for the encounter. For example, “My name is... I am a... year medical student, and I have come to talk to you to learn how to take a medical history.”

To establish rapport, and to put the patient at ease, it often helps to continue the interview by considering issues such as:

How they would like to be addressed (forename or surname) • Their physical comfort • That you will treat all information as confi dential • How the patient may end the consultation: “If at any time you • wish to stop this interview then please let me know.”

You will probably have a form similar to this one to fi ll in when seeing a patient. Some of the information may already be there but not always.

Surname: First name: Middle name:Address:D.O.B. Sex: Marital Status:Occupation: Presenting complaint:

For Marital Status, to avoid offending or embarrassing our patients, we should ask something like: Do you have a partner?Some possible answers to the question about marital status include:

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No, I’m singleI’m divorcedI’m separated I’m widowed

Yes, I’m married I’m living with my

husbandwifespousepartner

My husband

My wifeMy partnerMy spouse

passed away 2 years ago.

Note: Passed away = died. “Passed away” is much easier for people to say than died.Widowed means that the person’s spouse (husband or wife) has passed away (see above).

2- The present complaint and history of the present complaintIt is important to try to summarize the problem in a word or two words maximum, for example: headache and vomiting, vaginal bleeding, head injury, etc... and at this point, you should try to fi nd out exactly what the patient’s problem is and what symptoms he/she has by fi rstly letting him explain what the problem is and then by asking some supplementary questions to clarify what he or she has said. One way to get the ball roll-ing is to ask something like:What seems to be the problem?Can you tell what is wrong?Please tell me about your present trouble?Then followed by:What has happened since then?Have you noticed any other symptoms?When did it begin?

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How long has this been going on?What else have you noticed?

Pain is the most common symptom and the following table shows some common questions that doctors can ask when trying to establish the possible problem:

Feature of pain Typical ques on(s)Main area Where does it hurt?

Can you show me where it hurts?Radia on of pain Does it go anywhere else?

Does it hurt anywhere else?Characteris cs Can you describe the pain?Precipita ng features Does anything bring them on?When it happens When does it start?When it stops When does it stop?Frequency How o en do you get the pain?

Do you only get the pain in the morning/a ernoon/etc?

Aggrava ng factors Does anything make it worse?Is there anything that aff ects it?

Relieving factors Does anything make it feel be er?Associated features What else feels wrong when you have the pain?

Do you have any other problems related to the pain?

Dura on How long does it last?How bad it is How bad is it?

The following table shows how to describe painDescrip on of pain What it means...

Aching – an ache This is a general pain which is o en, but not only, found in muscles and joints.

Boring pain This pain is similar to a drill

Burning pain a pain with heat

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Colicky pain An intermi ent pain which changes in intensity, a pain which comes and goes

Cramp An involuntary spasmodic muscle contrac on

Crushing A feeling of pressure

Dull pain A pain which is in the background, opposite to acute or sharp pain

Gnawing pain A bi ng pain

Gripping A feeling of ghtness

Scalding pain Similar to extremely hot water

Sharp pain An acute pain

Stabbing pain A pain similar to a knife

S nging pain Sharp, burning, similar to an insect s ng or bite

Throbbing pain Intermi ent pain with a pulse or beat

3- Drug history.Because all drugs can cause ill effects, doctors need to know everything about the medication that the patient is taking or has taken, including herbal remedies or laxatives. It is essential to discover the identity of the drug, the dosage taken and how often the patient takes the medication and if the patient follows the dosage correctly. It is also necessary to speak about any drug allergies and any suspected reactions to drugs that the patient has.You can ask the following kinds of questions:

Details of drugs and medication:Are you taking any medication/tablets at the moment? What tablets do you take?What is the name of the tablets?Are you taking anything that your GP has not prescribed?Do you take any homeopathic medication?Are you taking any over-the-counter medication?Frequency:How often do you take your tablets?

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How many times a day?When do you take the tablets?

Compliance to treatment:Do you always remember to take your tablets?Do you often forget to take your medication?Side-effects and allergies:Are you allergic to any medication?Do you get any side-effects?

4- Past History.It is always a good idea to ask about previous illnesses that the patient may have suffered from.Have you ever suffered from...............?What childhood illnesses have you had? Do you have problems sleeping?Do you often get headaches?Have you ever experienced...................?Have you ever had a blood transfusion?Have you ever travelled abroad? What vaccinations have you had?Are you seeing any other doctors at the moment?Do you suffer from hay fever?Are you allergic to anything?

5- Family History.You should fi nd out the age, health and especially the cause of death, if applicable, of the patient’s parents, brothers and sisters, partner and children.Some appropriate questions for this are:Do you have any brothers and sisters?Do you have any children?Are all members of your immediate family alive?Are your parents alive?Is anyone taking regular medication?

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How old was he/she when he/she died?What was the cause of death?What did he/she die of?Does anyone in your family have a serious illness?

6- Social and personal history.You should try and fi nd out any relevant information about the patient’s occupation, housing and personal habits including his leisure time activi-ties. Include information such as physical exercise, alcohol and tobacco consumption. If the patient is a child, it is a good idea to ask about their relationship with their family and also about their school life. Some appropriate questions for this are:Do you live alone?What kind of house do you live in?Who do you live with?How old are your children?Are any of them at school?What do you do for a living?What’s your job?Do you have any problems at work/home?Do you have any money worries?Do you have any fi nancial problems?What are your hobbies?Do you do any sport? Which sport?Do you smoke? How many cigarettes do you smoke a day?Have you tried quitting?Do you drink?Do you drink wine, beer or spirits?Can you stop drinking when you want?How much do you drink a day/week?What is the most you will drink in a week?

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7- Patient’s ideas, concerns and expectations.At some time during the consultation we should try and fi nd out what the patient knows, what they expect, and what worries them about their problem. Remember the acronym ICE (Ideas, Concerns, Expectations).What do you know about this problem?What do you know about your condition?Do you have any idea about this illness?How do you think you got this illness?What do you mean by.........?What are your worries about your problem?Do you have any concerns?How will this affect your family?What do you expect to happen?What do you think will happen?What do you expect from us?What were you hoping we could do for you?

8- Further questions.You may need to ask more detailed questions to clarify the cause of the problem.Here we have a list of common questions:

Cardiovascular systemWhen did the pain start?Where does the pain go? Do you have diffi culty breathing when you are lying down? What about when you are walking?Have you been coughing? Have you felt faint?Have you lost consciousness at any time?Do you feel nauseous? Have you noticed any swelling in your ankles? Can you feel your heart beating?Have you taken your blood pressure recently?What was the reading?

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Do you get chest pains when you resting? What about when you are doing exercise?

Respiratory systemHave you had a blocked up nose?Do you have a runny nose?Is there any blood in the mucus?Do you have a sore throat?Is your voice affected?Do you smoke? Or Have you ever smoked?Have you ever worked in a mine or with dusty materials?Can you describe your cough?When you cough do you expel phlegm? Is there any blood in the phlegm?How many fl ights of stairs can you climb without stopping?Do you notice any noises when you breathe such as wheezing?

Alimentary and Genito-urinary systemsDo you have diffi culty swallowing?Does it hurt when you swallow?Have you lost weight recently?Have you been vomiting? How often do you vomit? When do you throw up? What colour is the vomit? How much do you vomit? How do you feel after you have vomited?Do you have a good appetite?Do you suffer from indigestion?Do you suffer from heartburn?Do you have any abdominal pain?How long has it been hurting for?Does the pain go away after you eat or take antacids?What colour are your stools? Do they contain blood?

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Do you have regular periods?Have you noticed any changes in your period?When you pass water, are there any changes in the stream?Do you pass wind frequently?Have you noticed any abdominal swelling?

Nervous systemDo you suffer from headaches? Do you ever vomit when you have a headache?Have you ever had a blackout?Have you ever had a fi t/seizure?Have you ever felt dizzy/giddy/light-headed? Do you get a feeling of vertigo? Do you lose your balance? Do you feel as if you are going to faint? Do you fall over? Do you lose coordination? Do you feel anxious or panicky?Do you get ringing in your ears?Have you ever experienced numbness or tingling in your hands or feet?Do you have any problem sleeping?Does light bother you?Can you see fl ashing lights?

Locomotor systemDoes it only hurt when you do physical exercise?Does the pain go away after you start moving?Are your joints stiff when you get up in the morning?Do you get about much?Do you suffer from backache?How long have you been suffering from.......................?

GeneralHave you had a temperature/fever?Do you suffer from night sweats?

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Does light/heat/cold bother you?Are you often thirsty? Do you drink a lot of liquids?Is your mouth sore?Do you sleep well? How much do you sleep?Are you always tired?Do you get angry easily?Do you often feel anxious?Do you often forget things?

Example of starting a medical historyPersonal detailsName: William Surname: SmithD.O.B: 04/04/74Hospital number: 03567897-WHospital department: PneumologySex: MaleMarital Status: Divorced

Present complaintPleuritic chest pain

History of the present complaintThe patient states he has suffered from pleuritic chest pain for the last three days, associated with a dry cough and shortness of breath, especially during exercise. The pain has been getting worse in the last few hours in his right hemithorax.The patient has not had a temperature or an increment in secretions. Past medical history- HTA (Hypertension) presently on tablets- Hypercolesterolemia- Obesity

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- Depression - DVT (Deep Vein Thrombosis) three years ago associated to a bilat-eral PE (Pulmonary Embolus) and since then has been on treatment with warfarine

Drug history and allergies- Warfarin 2mg od (once a day) o (orally= po)- Paracetamol 1g. tds (four times a day) prn (if required)- Lisinopril 5 mg od o- Atenolol 25 mg od o- Omeprazol 20 mg od o- Seroxat 20 mg od o- Duphalac 10 ml bd (twice a day) o

Allergic to penicillin

Smoking* and alcohol history* Pack years= nº of years patient smoked 20/ day. Eg. if patient smoked 10/day for 50/years= 25 pack years.He smokes more than 20 cigarettes a day.Has a daily alcohol intake of about 20 units, including heavy spirits at night time.

Social , occupational and family historyThis 35 year old man has lived on his own in a very deprived area of Lon-don since last year. He lost his wife and his only son in a tragic car accident when he was driving under the infl uence of alcohol.He is presently unemployed and has refused several attempts at rehabilita-tion. He was not helpful during the medical interview.

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REFERRAL AND DISCHARGE LETTERS

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93

CLINICAL EXAMINATION


Our aim in this chapter on medical examination is not to teach you how to carry out a medical examination but to help you out with the most com-mon medical terminology and the way the information is presented.

General principles of the physical examination:Privacy and warmth are essential both on a hospital ward and in an out-patient department.Lighting should be good and there should be adequate exposure of the area to be examinedEnsure that both patient and the examiner are warm. Most of the clinical examination is best conducted from the patient´s right side if the clinician is right-handed and the opposite is true if they are left-handed.Examine the patient as thoroughly as possible without exhausting them.Remember to handle any painful area as gently as possible. Breathless patients should be examined semi-recumbent as they will be more out of breath when lying fl at.(Young) female patients require special consideration by male health professionals. Asking for a chaperone may be a good idea.Record your examination fi ndings systematically. Identify the patient´s problems and then decide on a management plan.

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General assessment

Things to check:

Patient’s demeanour and general appearance Their posture and gait Physique and nutritional status State of hydration and presence of oedema Height, weight, and BMI Finger clubbing, lymphadenopathy Thyroid and breasts Skin and subcutaneous tissues

1 - The Respiratory System

Cardinal symptoms are: cough, sputum, haemoptysis, breathlessness, chest pain, wheeze, stridor.

Cough Coughs vary in nature depending on the cause. They may be harsh, dry and paroxysmal or loose and readily productive of sputum

Sputum Sputum may be mucoid (grey, white or clear), purulent (yellow or green) or mucopurulent (a mixture of the two)

Haemoptysis Haemoptysis can vary in quantity from slight blood-staining of sputum to massive haemor-rhaging

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Breathlessness (dyspnoea) Breathlessness (dyspnoea) may be experienced only on exertion, or may occur in attacks when the patient is at rest. Exertional breathlessness should be assessed by asking about exercise tolerance; for example, “how many fl ights of stairs can you climb without stopping?”

The speed of onset and the duration of some respiratory causes of breathlessness may be di-agnostic such as:

Acute onset (hours/days): pulmonary embolism, pneumonia. Intermediate (days/weeks): pleural ef- fusion. Chronic (months/years): chronic ob- structive pulmonary disease.

Chest pain Chest pain caused by pulmonary disease is characteristically unilateral and aggravated by deep inspiration and coughing “pleuritic chest pain”.

Wheeze Wheeze is a musical sound usually more con-spicuous during expiration.

Stridor Stridor is a “crowing” sound occurring during inspiration and aggravated by coughing; it is due to obstruction of the large airways (larynx or trachea).

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Most common Breathing sounds

Bronchial breathing sounds

Both inspiratory and expiratory sounds are loud and blowing in character, similar to those heard through the trachea. There is an increase in conduction of spoken and whispered sounds, vocal resonance and whispering pectoriloquy.

Rhonchi (Wheezing) Rhonchi are musical sounds of high, medium or low pitch produced by the passage of air through narrowed bronchi. E.g. asthma.

Crepitations (crackles) Crepitations are non-musical sounds with a crack-ling quality. In some cases crepitations indicate excess secretions in the small airways. They are audible throughout inspiration. E.g. pulmonary oedema.

Pleural Rub A pleural rub is a creaking sound produced by movement of the viscera over the parietal pleu-ra when both surfaces have been roughened by a fi brinous exudate. It sounds like the crunch-ing noise of footsteps in crisp snow or like the creaking of leather.

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2 - The Heart

Cardinal symptoms are: chest pain, oedema and palpitations.

Chest pain Chest pain caused by myocardial ischemia (an-gina pectoris) is characteristically related to exercise. It is relieved within a few minutes by resting. The pain is described as a “tightness” or “heaviness”, sometimes as “indigestion” or even “breathlessness”. The main site is usually retrosternal. Radiation commonly occurs to the left shoulder and arm, but the pain may be felt exclusively in either or both arms, the neck, back or epigastrium. The pain of myocardial infarction may be accompanied by breathless-ness, nausea, sweating and a sensation of im-pending doom (angor animi).

Breathlessness Breathlessness occurring on exertion and relieved by rest is usually the earliest symptom of left heart failure. The cough and watery, frothy and sometimes blood-stained sputum are frequent accompanying features. Breathlessness associ-ated with lying fl at is known as orthopnea.

Oedema Oedema of cardiac origin is due to the hydrostat-ic effects of cardiac failure and changes in renal function causing salt and water retention.

Palpitation Palpitation is an awareness of the heart beat. This can be caused by fright, anxiety, ectopic beats or arrhythmias.

Syncope Syncope is sudden transient loss of conscious-ness; presyncope is the sensation of faintness without loss of consciousness.

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Most common heart sounds.

The fi rst heart sound (S1)

The fi rst heart sound (S1) is best heard at the apex and is mainly due to closure of the mitral valve. The intensity varies with the presence of mitral regurgitation (reduced) and mitral stenosis (increased).

The second heart sound (S2)

The second heart sound (S2) is best heard at the left sternal edge in the second intercostal space. It is caused by closure of the aortic and pulmonary valves. During inspiration, closure of the pulmonary valve is delayed, producing the normal physiological splitting.

The third heart sound (S3)

The third heart sound (S3) imparts a typical cadence to the heart sounds “lup-dup-dum”-S1-S2-S3. It is also a common feature of mitral incompetence.

The fourth heart sound (S4)

The fourth heart sound (S4) is coincident with atrial contraction and thus precedes the fi rst heart sound. The term “gallop rhythm” is sometimes used to describe a triple rhythm associated to tachycardia.

An opening snap of the mitral valve

An opening snap of the mitral valve is pathognomonic of mitral stenosis and occurs soon after the second sound.

A pericardial friction rub

A pericardial friction rub is characteristic of pericarditis. It is a creaking or rustling noise often with three compo-nents in each cardiac cycle, sounding like “chi-te-chi”.

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Murmurs We can describe murmurs in different ways depending on the area over the murmur where it is best heard:

Site: the area where a murmur is best heard depends • on the valve of origin or cardiac defect and the di-rection of blood fl ow e.g. mitral murmurs.Radiation occurs along the line of blood fl ow, e.g. • mid-systolic murmur (ejection). Pitch, as a general principle, the greater the pressure • gradient, the higher the pitch. E.g. the murmur of mitral stenosis is low-pitched. Timing, murmurs are timed in relation to the fi rst • and second heart sounds, murmurs are usually di-astolic or systolic.Intensity of murmurs may be an index of their clin-• ical signifi cance. Grade I = just audible by an expert,Grade II = audible by a non-epert in optimal conditions Grade III = moderately loud Grade IV = loud and accompanied by a palpable thrill,Grade V = very loud, Grade VI = audible without stethoscope.

3 - The alimentary and genitourinary systems

Cardinal symptoms are: loss of appetite, diffi culty in swallowing, heartburn, abdominal pain, nausea, vomiting, weight loss, gastrointestinal bleeding, alteration in bowel habit and jaundice.

Loss of appetite Loss of appetite or anorexiaDysphagia diffi culty in swallowing and odynophagia

which is pain on swallowing

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Heartburn Heartburn is a retrosternal burning dis-comfort. It results from gastro-oesophageal refl ux due to incompetence of the lower oesophageal sphincter.

Abdominal pain. E.g. Duodenal ulceration causes pain which is usually localised to the epigastrium but can also radiate to the back. It is gnawing in character and of moderate severity. The pain usually lasts for up to 2 hours but can be relieved within 15 minutes by eating or by antacids. It often occurs before meals.

Weight loss Weight loss is common in malabsorption syndromes and may be the presenting symptom of GI malignancy.

Vomiting The diagnostic features may be the fre-quency and timing of vomiting, quantity, contents and colour.

Gastrointestinal haemor-rhage

The colour of the blood lost may indicate the source of bleeding. Bright red blood in the vomitus is usually oesophageal; bleed-ing from the stomach or duodenum results in a “coffee-ground” appearance in the vomit. Upper GI bleeding produces black stools (melaena).

Altered bowel habit Altered bowel habit may be an early symp-tom in colonic malignancy.

Jaundice Jaundice is associated with hepatitis or bil-iary obstruction and causes dark urine and pale stools.

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Most common fi ndings from the examination

Slow waves Slow waves passing from the left sub-costal area to and across the midline are most easily observed on tangential in-spection.

Small bowel peristalsis Small bowel peristalsis is seen as writh-ing movements in the central abdomen.

Localised tenderness Localised tenderness (pain on touch) is usually associated with organic disease.

Peritonitis Peritonitis (generalised rigidity) com-monly implies failure of the patient to relax.

Rebound pain The pain produced by the sudden re-moval from the abdomen of a fi rmly applied hand.

Murphy´s sign Murphy´s sign is the tenderness below the midpoint of the right costal margin which is accentuated by, or limits, deep inspiration.

McBurney´s point McBurney´s point is the tenderness over an area a third of the way between the right superior iliac spine and the umbili-cus.

Resonant percussion Resonant percussion is the sound of the percussion on the abdomen due to the gaseous distension and the swellings overlaid by gas.

Ascites Ascites free fl uid in the abdomen out-side the gut with ascites, gut containing gas fl oats uppermost, while fl uid accu-mulates in both fl anks when the patient is lying supine.

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Central dullness on percussion This is the result of the pelvic masses extending into the abdomen causing dis-placement of bowel and fl anks.

Gastric succussion splash A gastric succussion splash can normal-ly be elicited 1-2 hours after a meal. If present several hours after the meal, it suggests the presence of gastric outlet obstruction.

Gurgling bowel sounds Gurgling bowel sounds are characteris-tic of abnormal peristaltic activity and can be heard with the stethoscope every 5-10 seconds.

High-pitched bowel sounds High-pitched bowel sounds are charac-teristic of mechanical obstruction.

Silent bowel sounds Silent bowel sounds are characteristic when the bowel is rendered inactive (paralytic ileus) as in general peritonitis.

4 - The nervous system

Cardinal symptoms are headache, dizziness, blackout, visual impairment, deafness, paraesthesia, weakness, sphincter dysfunction.

Headache or cephalalgia Headache or cephalalgiaDizziness, giddiness or light-headedness

Dizziness, giddiness or lightheadedness may mean different things such as loss of balance, loss of coordination as if about to fall over, falling to the ground without loss of consciousness, feeling as if about to faint (presyncope) as well as feeling anxious and panicky.

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Blackout (unconsciousness) Blackout (unconsciousness) may be sud-den in onset and without warning, or gradual in onset and heralded by feeling faint and lightheaded.

Visual impartment This may comprise:photophobia - intolerance to • light, photopsia - seeing fl ashes and • zigzags of lights,diplopia - double vision, • amblyopia - blurred vision, • scotoma - loss of part of the • fi eld of vision of one eye, hemianopia - loss of half of • the fi eld of vision of both eyes or quadrantanopia - loss of one-• quarter of the fi eld of vision of both eyes.

Deafness Deafness is common with advancing age. Tinnitus, a buzzing or ringing in the ears, when associated with deafness, suggests inner ear disease.

Paraesthesiae Tingling and numbness. Weakness Weakness.Sphincter dysfunction Sensory loss in the bladder leads to pain-

less urinary retention which after a time overfl ows.

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Most common fi ndings from the examination

Speech problems

Dysphasia. Impairment of language function may be:

Expressive (motor), when pa-• tients understand what is said and know what they wish to say but are unable to say it.Receptive (sensory) when there • is impariment of comprehen-sion. Global dysphasia when there is • a combination of both.

Dyslexia Dyslexia is the inability to understand written language.

Dysarthria Dysarthria is when there is a diffi culty in the articulation due to defective move-ments of lips, tongue or palate.

Dysphonia Dysphonia is when there is a problem with sound production, usually due to vocal cord lesion.

Motor system

Muscle wasting (atrophy) This is common in conditions associated with physical inactivity.

Fasciculation This refers to visible twitching of mus-cle.

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Tremors Tremors are a result of alternate con-traction and relaxation of groups of muscles producing rhythmic oscillations around a joint or group of joints. They may be an action tremor, resting or in-tentional tremor.

Choreiform movements Choreiform movements are irregular, jerky, ill-sustained and appear semi-pur-posive.

Athetoid movements Athetoid movements are slow, writhing movements of the distal parts of the limbs in particular.

Myoclonus Myoclonus is sudden, shock-like move-ments of a whole limb.

Tics Tics are repetitive, localised and jerky.Hypertonia (increased tone) Hypertonia is of two distinct types:

spasticity (pyramidal tract dis-• orders) andrigidity (extrapyramidal tract • disorders).

Hypotonia (decreased tone) Hypotonia occurs in disorders of the lower motor neurone and cerebellum.

Clonus Clonus is the rhythmic repetition of in-voluntary muscular contractions caused by a sudden passive stretching of a mus-cle.

Babinski sign (extensor plantar response)

Babinski sign: a lesion of the upper mo-tor neurone which causes dorsifl exion of the big toe and often a fanning of the other toes.On stimulation of plantar surface of foot.

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Coordination

Sensory ataxia Sensory ataxia is the incoordination resulting from defective propriocep-tion which is normally modifi ed by visual feedback.

Cerebellar ataxia Cerebellar ataxia is an incoordination that is not susceptible to visual com-pensation. Dysmetria is when the pa-tient tends to “overshoot” the target, even with their eyes open.

Romberg’s test A Romberg´s test is positive when the patient is unable to stay balanced in a standing position after eye closure.

Stereognosis The ability to distinguish shapes, con-tours and textures (complex touch).

Two-point discrimination The ability to perceive two simultane-ous stimuli as distinct when separated by minimal distances.

Sensory inattention The inability to perceive two simulta-neous stimuli at corresponding sites on both sides of the body.

Dyspraxia Patients write slowly and with diffi -culty.

Cranial nerves

Anosmia The loss of the sense of smell.Horner´s syndrome This is the ptosis and miosis of the

same eye.Miosis Constriction of the pupil of less than

3mm.Mydriasis When dilation (or dilatation) is above

5mm.

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Direct light refl ex This is the reaction of the pupil on the stimulated side.

Consensual light refl ex This is the constriction of the other pupil.

Accommodation refl ex This is the constriction of the pupils occurring in response to convergence of the eyes on a near object.

Strabismus Strabismus or squint.Nystagmus Nystagmus is involuntary rhythmic os-

cillation of the eyes. It is either pendu-lar or jerking in type.

Supplementary

Neck stiffness Painful restriction of passive fl exion of the neck due to meningeal irritation.

Kernig´s sign When the meningeal irritation also restricts pas-sive hip fl exion, inducing spasm of the hamstrings that prevent full extension of the knee.

Example of case report (continuation of the part I “starting a medical history”)

Physical examinationGeneral: The patient is not cooperative and uses rude vocabulary to talk to the staff. Personal hygiene is also poor.Nutritional status seems to be poor.Bilateral gynecomastia.Jaundice can also clearly be seen in the sclera , beneath the tongue and also on the skin.

Respiratory: The patient is breathless at rest, sitting down on a chair.Pigeon chest type chest wall deformity. On examination, there is found to be poor air entry on the left base of the lung and crackles. Dull, bilateral percusion also noted on the same side.

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Productive cough -purulent sputum on tissue- and temperature (38) registered by the nurse.Hyperinfl ation and use of intercostal muscles. Also, some degree of abdominal breathing.

Cardiovascular TA 160/98 HR at 110. Irregular pulse. Increased jugular venous pres-sure for about 4 fi ngerstips. There is an ejection systolic murmur on his right carotid artery and an ejection systolic aortic murmur. The third heart sound (S3) is present.Displaced apex to the left side.Peripherial pulses are weak.Bilateral pitting oedema in both lower legs. Chronic atrophic vein changes are also present.

Abdomen: There is an abdominal scar on his right lower quadrant abdomen -previous apendicectomy.No pubic or axilary hair.Tender Hepatomegaly of 6 fi nger-widths is present.Palpation of the rest of the abdomen- no tenderness, no rigidity ,no rebound noted.Bowel sounds were present.Digital examination did not show anything relevant, just impacted feaces in rectum and an enlarged prostate. No hernias. No testicular swellings.

NeurologySpacial disorientation and dysphasia.Relevant muscle wasting and hypotonia.Sensory system seems to be altered but it is diffi cult to say because the patient is not helpful.

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Clinical impressions (fi rst diagnosis prior to the investigations)-Heavy smoker-Alcohol intake-Malnutrition-Hypertension-Atrial fi brilation?-Aortic valve stenosis?-Left heart failure?-Pneumonia on left base of lung?-Right carotid stenosis?-Icterus and ascitis. Decompensated liver disease?-Encephalopathy?

First line of investigations-Full blood account-Biochemistry including liver function tests , bilirubin levels and clotting tests-Blood gas-ECG-Chest X-ray-Sputum culture-ECHO-doppler: Neck and heart-Abdominal ultrasound-Abdominal puncture for ascitis aspiration-Urine analysis

Further investigationsThis will depend directly on the results of our fi rst investigations and the clinical situation of the patient.

Continuing care-Record treatment plans and progress notes on a daily basis-Record all the new diagnoses established-List any unexplained facts about the patient´s active problems-Update the problem list as the initial problems resolve and new problems arise-Date and sign all progress notes

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WRITING AN ABSTRACT AND ARTICLE

WRITING AN ABSTRACT/ARTICLE

For doctors who don’t use English as their fi rst language, writing an arti-cle or report in English can be a very worrying and stressful experience. It doesn’t need to be like that. In this chapter we will be giving you, the medical professional, tips on how to present your ideas in a clear, concise and professional way.

One good way to get good ideas on how to write your article is to fi nd and read articles that are similar in nature to the article you want to write. You will be able to get ideas on vocabulary, grammar structure and ex-pressions used in the fi eld.

There is a clear layout that should be followed when writing the heading to an article:

The title.1. List of authors with e-mail addresses.2. Full professional contact details of the main author(s). 3. Declaration.4. Key words: 5-10 words which help to classify the article.5. (Only if required)

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Example.

The Abstract:When submitting your article to a journal you must usually include an

abstract with your article (if required). Approximately 150 - 250 words is an acceptable length. You must remember that an abstract is not just an introduction to your article but is a synopsis of it. You should tell the reader what they will know when they have fi nished reading the article it-self. Most publications ask that the abstract be divided into four sections: Objective, Materials and Methods, Results and Conclusion.

Objective: Here you must explain the reasons for and purposes of the study or

investigation and the hypothesis that you are testing or the procedure you are evaluating.

One good way to begin this section is by using an infi nitive:

To evaluate if The ODM (Oesophageal Doppler Monitoring) is a clinically proven alternative to the Swan-Ganz pulmonary artery catheter (PAC) in helping determine a patient’s physical condition. It is less invasive, easy to insert and relatively risk free. The values measured by ODM generally correlate well with the same values measured by PAC. Similar caveats apply to the

Oesophageal Doppler Sancho Rodriguez Villar, Andy MearsCorresponding author contact details:Sancho Rodríguez Villar Intensive Care Unit. Toledo General Hospital. [email protected]

The authors declare that they have no competing interests and that no fi nancial support was provided for this study.Key words: infection, eosinopenia, infection marker, critically ill patient, eosinophil, monocyte

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interpretation of ODM and PAC values: Use trends rather than single values; and interpret the readings in conjunction with other fi ndings.

To evaluate the patient’s physical conditionTo present our fi ndings after a 5 month study carried out on critically ill patients.To study.......To demonstrate.......To assess.......To compare.......To perform.......To determine.......To establish.......To investigate .......You can also start with: The aim of the study was to evaluate if the ODM is a clinically viable alternative to the Swan-Ganz pulmonary artery catheter(PAC) The objective of the investigation was to demonstrate............The goals of the study were to............The purpose of this research was to............The goal of personalised medicine in the intensive care unit (ICU) is to predict which diagnostic tests, monitoring interventions and treatments translate to improved out-comes given the variation between patients.

Giving background information before saying what you did is also pos-sible:

We compared............We hypothesized that............This study was designed to............We investigated ............We researched............The search for early parameters of a well-fi lled ventricle..

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Materials and method: You should briefl y say what you did and what materials you used during the research and also the number of subjects studied. You should also mention how you made your assessment and how you controlled bias.

N patients with ............were included. (N= number)N patients were known to have.............N patients were suspected of having.............N patients underwent..............N patients admitted..........were included in the study.Patients were followed clinically for.............(time = days/months/years)

Results: This section is for you to lay out the results of the study or research. You should include statistical information including actual numbers as well as percentages. 244 patients were included in the study: 52.9% (129) were medically ill patients, 22.5% (55) were post-surgical and 24.6% (60) were polytrauma patients. APACHE II: 14.9+8.9 .55 patients out of 244 (22.5%) suffered from an infection.

Seven studies combined SOFA-based derivatives with admission severity of illness scores, and they all reported improved predictions for the combination. Quality of studies ranged from 12.8 to 19.3 points on a 20-point scale.

Conclusion: You should summarise, in one or two sentences, the conclusions reached based on the results of your study or research. Any new observations or aspects of the research should be mentioned here.

Laparoscopic appendectomies and OAs are comparable for complications, postopera-tive pain control, length of hospitalization, and recovery time. Patients who underwent an OA had a shorter operative time and lower operating room and hospital charges. Therefore laparoscopic appendectomy does not offer any proven benefi ts compared with the open approach for the average patient with acute appendicitis.

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Liposomal cytarabine is effective and well tolerated in the treatment of LM, and should be considered as an agent of choice for the treatment of this complication.

These results demonstrate that GI growth factors as well as gastrointestinal hor-mones/neurotransmitters with different cellular basis of action can all regulate Akt phosphorylation in pancreatic acinar cells.

The ODM is a clinically proven alternative to the Swan-Ganz pulmonary artery catheter (PAC) in helping determine a patient’s physical condition. It is less invasive, easy to insert and relatively risk free. The values measured by ODM generally cor-relate well with the same values measured by PAC.

Keywords:Just under the abstract, you should write a short list of keywords or two word phrases, between 5 and 10, to help indexers classify your article. They may be published with your abstract. A good idea is to use terms that are included in the Medical Headings list of the Index Medicus at (www.nlm.gov/mesh/meshhome.html).

The Article:Main text:A good, generally accepted way to plan out your article is to divide it into four sections; Introduction, Methods, Results and Discussion. The Results and Discussion sections may also need subheadings in longer articles, for clarity. When writing an article you will fi nd that using an acronym is sometimes faster than writing out a long word. If possible avoid doing so but if you feel it is necessary you should always write out the word in full the fi rst time followed by the acronym between brackets. e.g. magnetic resonance imaging (MRI).

Introduction: Your article should begin with a short introduction that tells the reader some background information on why the study was done and makes reference to other studies and/or literature dealing with the subject. You should not go into great depth at this point. The last paragraph of this

116


section should clearly state your hypothesis and your reasons for doing the study. Be brief and to the point.

Materials and methods: Next you should explain the details of the subjects of your study (pa-tients, lab animals) including any control groups. You should specify age, sex and any other important aspects of your subjects such as ethnic group. You should say why things like age, sex, ethnicity are important to the study as this may not be clear to the reader. Remember clarity is the key. You should give your reasons for including or excluding certain groups, e.g. explaining why children were excluded or why only people under the age of 30 were included. A description of how the data was collected and what terms were used in surveys should be included.

Our study group was selected from.............N patients with proven.............N patients were followed clinically.............N patients with known or suspected............. were included in /excluded from this study.............N patients were examined before/during/after.............N patients (N men/N women, age range: N-N years, mean: N+N years).In total, 350 men, aged 18 to 54 years (mean 36 years)...(fulfi lling XXX criteria)... were included in the study. All patients admitted to the ICU from January to May 2009 were included in the study, excluding patients spending less than 12 hours in the unit (due to ward transfer or death).

Next, you should give details of all methods, instrumentation and proce-dures followed so that others can reproduce your study. (Any trade or man-ufacturer’s names can be added afterwards in brackets). Specify what drugs or chemicals were used including dosage, administration routes, and generic names. Do not use drug trade names if it is not directly signifi cant.

A range of sedating agents are used by the surveyed ICUs. Propofol is the most fre-quently used sedating agent for patients with an expected length of admission to ICU

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of less than 24 hours. For an expected admission to ICU of more than 24 hours, midazolam and propofol are the most commonly used agents.

An 8.5-Fr introducer (CC-350B; Baxter, Deerfi eld, IL, USA) was inserted per-cutaneously in the left external jugular vein and a 5-Fr introducer (CP-07511-P; Arrow International, Inc., Reading, PA, USA) was inserted into the ipsilateral common carotid artery.

The patients were placed in a semi-recumbent position and were ventilated in pres-sure control mode by a Servo ventilator (Maquet AB, Sweden) via a heat moisture exchange fi lter (Barrierbac “S”, Mallinckrodt DAR, Mirandola, Italy). A closed suction system (TRACH-Care 72, Ballard Medical Products, Draper, UT, USA) was used.

You must explain how the studies were evaluated. e.g. include any inde-pendent readings or consensus readings, state whether they were evalut-ed blinded or unblinded to other information, note time sequencing be-tween readings of several studies of the same patient or animal to elimi-nate recall bias and detail the random ordering of studies. The nature of your study i.e. retrospective or prospective, should be made clear.

Entry/inclusion criteria included …These criteria had to be met: …Patients with … were not included.Further investigations, including … and …, were also performed.We prospectively studied N patients with …The reviews were not blinded to the presence of …Both the interventional cardiologists and echocardiographers who performed the study and evaluated the results were blinded to drug administration.Histologic samples were evaluated in a blinded manner by one of the authors and an outside expert.

Give references to established methods, including statistical methods that have been published but are not well known; describe new or sub-stantially modifi ed methods and give reasons for using these techniques,

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and evaluate their limitations. Identify, precisely, all drugs and chemicals used, including generic names, doses, and routes of administration. Do not use a drug’s trade name unless it is directly relevant.

Patient characteristics were classifi ed into time-independent factors and time-dependent factors. Time-independent factors included demographic (age, sex), clinical (admission diagnosis, admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and admission Therapeutic Intervention Scoring System (TISS) score) char-acteristics.The imaging protocol included ..............To assess objectivity, all patients were scored using the SCORAD method.

Statistics:Describe statistical methods with enough detail to enable a knowledge-able reader with access to the original data to check the reported results. Put a general description of methods in the Methods section. When data are summarised in the Results section, specify the statistical methods you used to analyse them.

The Kaplan-Meier method was used to calculate the probability of …......To test for statistical signifi cance, …......A statistically signifi cant difference was calculated with the Fisher exact test.Statistical analyses were performed with …......and …......tests.The levels of signifi cance are indicated by Pvalues.All P values of less than 0.25 were considered to indicate statistical signifi cance.Univariate and multivariate Cox proportional hazards regression models were used. Give details about randomisation:

One physician selected them consecutively between May 2001 and July 2003.This study was conducted prospectively over a period of 24 months from March 2001 to February 2003. We enrolled 36 patients who had …

Specify any general-use computer programs used:

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Statistical tests were performed with the SAS 6.12 software package (SAS Institute Inc., Cary, NC, USA).Statistical methods were chosen after consulting a biostatistician, and the statistical analyses were performed using Statistica 6.0 (StatSoft, Tulsa, OK, USA).

Results: Present your results in a logical sequence in the text, along with tables, and illustrations. Do not repeat in the text all the data in the tables or il-lustrations; empathise or summarise only important observations. Avoid non-technical uses of technical terms in statistics e.g. ‘random’ (which implies a randomising device), ‘normal’, ‘signifi cant’, ‘correlations’, and ‘sample’. Defi ne statistical terms, abbreviations and most symbols: Statistically signifi cant differences were shown for both X and X.Signifi cant correlation was found between X and X.Results are expressed as mean +/- SD.The abnormalities were correctly characterized in N patients and incorrectly in …The preoperative and operative characteristics of these patients are listed in Table 3.The clinical fi ndings are summarized in Table 6.Report any complications you found: A total of 302 UK ICUs were identifi ed and responses were received from 192 (63.5%). Seven of these responses were excluded from further analysis; fi ve were high dependency units that do not admit ventilated patients, and two questionnaires were returned blank.Two minor complications were encountered. After the second procedure, one patient had a slight hemoptysis that required minor treatment, and one patient had local chest pain for about 60 minutes after a puncture in the supraclavicular region.Among the 10,206 patients, there were 347 in-hospital deaths (3.4%), 184 intraop-erative/postoperative CVAs (1.8%), 327 patients with postoperative bleeding events (3.2%), and 133 patients with sternal wound infections (1.3%).

Give numbers of observations. Report any losses to the observation (such as drop-outs from a clinical trial or death of a subject):

The fi nal study cohort consisted of …

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Between June 2007 and May 2008, nurses’ questionnaires were collected for 56 pa-tients. The study period of 20 days was completed by 48 patients (88%); four patients died within the study period, two patients withdrew their consent and two patients were transferred to other hospitals.

Discussion: In this section, you may use several subheadings. You should emphasize all the new and important aspects of your study and any and all conclu-sions that come from them. You should not repeat the data already given in the Introduction section or the Results section in detail. You should include the implications of the fi ndings as well as their limitations in-cluding any implications for future research or study. You should make reference to other relevant studies or research.

Link the conclusions of the study to the original goals of the research but avoid making unqualifi ed statements and conclusions that are not completely supported by the data collected. You should not make any statements on possible economic benefi ts and costs if you do not in-clude economic data and analyses in your article.You should not make reference to work that has not been completed or claim priority. Hypotheses should only be given if they are warranted.

If you think that recommendations are appropriate you may include them.In conclusion …In summary …This study demonstrates that …This study found that …Another fi nding of our study is …A limitation of our study is that …Our results support …Further/More research is needed to understand …The limited case number warrants a more comprehensive study to confi rm ...............Some follow-up is probably appropriate for these subjects.Further research will be needed when...........

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Acknowledgements: You should include all the contributors who do not meet the criteria for authorship, e.g. people who only gave technical or writing help, or only general support. Any fi nancial and material support should also be mentioned.

People who have materially helped with the article but do not merit authorship can be included using the heading ‘clinical investigators’ or ‘participating investigators’ and their function or contribution can be described: ‘worked/served as scientifi c advisors’, ‘reviewed the study proposal’, ‘were responsible for collecting data’, ‘provided and cared for study subjects’, ‘involved in interpreting the results’.

Remember that it is necessary to get written consent to include anybody in the acknowledgments because readers may assume that they are en-dorsing the study.

EdJ designed the study and drafted the manuscript. LP and NdK were involved in the set-up of the study, performed the statistical analyses and helped in interpreting the results and writing the manuscript. PK was involved in the set-up of the study, interpreting the results and writing the manuscript. JJ, DdL, PvdV, RB, RdW and RW were involved in interpreting the results and writing the manuscript. All authors read and approved the fi nal manuscript.

MM, BG and FA designed the study, analysed and interpreted the data, and drafted the manuscript. FV, SWB, PK, JPF, C, FC and FL were responsible for data acquisition, analysis and interpretation. EV and CMG were responsible for data management and statistical analysis.

References: You should number the references consecutively in the order they fi rst appear in the article. Identify references in text, tables and legends with Arabic numerals in brackets, i.e. (1,2,3). References that are only men-tioned in tables or legends should be numbered according to where the table or legend is fi rst mentioned in the text.

122

Baseline characteristics including demographics, history and type of infection, and laboratory test results were obtained within the 24 hours before randomisation. Dis-ease severity at baseline was assessed using the Simplifi ed Acute Physiology score II and the Sequential Organ Failure Assessment score (16,17).

The variables are used to calculate probabilities of death for each patient using the Acute Physiology and Chronic Health Evaluation (APACHE) II (19), the Simpli-fi ed Acute Physiology Score (SAPS) II (20), and the Mortality Probability Models (MPM) II at admission and 24-h scoring systems (21).

You should follow the styles of the examples given below. All of the ex-amples are based on formats used by the National Library of Medicine’s Index Medicus (http://nlm.nih.gov/). You should use the abbrevia-tions for journals that appear in Index Medicus.

Guidelines for acknowledging articles in journals:

General Rules for Author:1. List names in the order they appear in the text.o Enter last name/surname for each author.o Capitalize surnames. o Convert given/fi rst names and middle names to initials; give a maxi-o mum of two initials following each surname.List all of the authors’ names or at least six followed by ‘et al’ to o indicate there are more. Separate authors’ names from each other by a comma and a space o End author information with a full stop/period(.)o

2. General Rules for Author Affi liation (optional):Enter the affi liation of only the fi rst authoro Begin with the department and name of the institution, followed by o city and state, province and/or country.Use commas to separate parts of the affi liation. o Place the affi liation in brackets, such as (Department of Psychology, o University of Cardiff, Cardiff, Wales, United Kingdom).


123


Separate the affi liation from its author by a space. o Follow the affi liation with a comma placed outside the closing o brackets. If it is the affi liation of the last author use a full stop.

3. General Rules for Article Title:Enter the title of an article as it appears in the original publication. o Capitalize only the fi rst word of a title, proper nouns, proper adjec-o tives and acronyms.Use a colon followed by a space to separate a title from a subtitle, o unless some other form of punctuation (such as a question mark, period, or an exclamation point) is already present. Translate non-English titles into English and place the translation o in square brackets [ ].End a title with a period unless a question mark or exclamation o point already ends it or an Article Type follows it.

4. General Rules for Article Type (optional):An article type lets the reader know that the reference is to an ab-o stract of an article or a letter to the editor, not a full article. Write [abstract] or [letter] after the article title. o Other article types can also be used although less often, such as o ‘book review’, ‘editorial’, or ‘interview’.Follow the bracketed article type with a full stop placed outside the o closing bracket (e.g. [abstract]).

General Rules for Journal Title:5. Enter a journal title in its original language. o Cite a journal name as it was published at the time. o Abbreviate signifi cant words in a journal title and omit other words, o such as articles, conjunctions, and prepositions. Capitalize all remaining title words, including abbreviations. o End the journal title with a full stop except when an Edition is in-o cluded, then use a space.

124


General Rules for Edition:6. Indicate the edition/version being cited after the title if a journal is o published in more than one edition or version. Abbreviate each signifi cant word and omit other words, such as ar-o ticles, conjunctions, and prepositions. Capitalize all words. o Place the edition statement in parentheses, such as (Br Ed). o End the edition statement with a full stop.o

General Rules for Date of Publication:7. Include the year, month and day of publication in that order. For o example: 2009 May 23. Convert roman numerals to Arabic numbers, such as MCMXCVI o to 1996. Use English names for months and abbreviate them using the fi rst o three letters, e.g. February=Feb. End date information with a semicolon unless there is no volume or o issue, then end with a colon.

General Rules for Supplement/Part/Special Number to a Date:8. Place a supplement, part, special number, or other division to a year o after the date. Abbreviate these: Supplement = Suppl, Part = Pt, Special number o = Spec No. Include numbers and letters accompanying them. For example: Pt o 2 or Suppl B.Only use Arabic numbers. For example: convert Suppl III to Suppl 3.o End the supplement, part, special number with a colon unless fur-o ther divisions exist.

General Rules for Volume Number:9. Omit “volume”, “vol.”, and similar wording preceding the number. o Only use Arabic numbers. Convert L or Fiftieth to 50.o Separate multiple volumes with a hyphen, such as 7-8 or 52-53. o Do not follow volume number(s) with any punctuation unless there o

125


is no issue number or other subdivision to the volume, then follow with a colon.

General Rules for Supplement/Part/Special Number to a Volume:10. Place a supplement, part, special number, or other division to a year o after the volume number. Abbreviate these: Supplement = Suppl, Part = Pt, Special number o = Spec No. Include numbers and letters accompanying them. For example: Pt o 2 or Suppl B.Only use Arabic numbers. For example: convert Suppl III to Suppl 3.o Place parts in parentheses, such as 48(Pt 2); other divisions have no o punctuation around them, such as 48 Suppl.End the supplement, part, special number with a colon except when o further divisions exist or an issue number is present.

General Rules for Issue Number:11. Omit “number”, “no.”, and any other words that come before the o number.Only use Arabic numbers. For example: convert Suppl III to Suppl 3.o Separate multiple issues by a hyphen, such 6-7. o Place issue information in brackets.o End issue information with a colon except when further divisions, o such as a supplement or part, exist.

General Rules for Supplement/Part/Special Number to an Issue:12. Place a supplement, part, special number, or other division to an o issue after the issue number and inside the brackets.Abbreviate these: Supplement = Suppl, Part = Pt, Special number o = Spec No.Include numbers and letters accompanying them. For example: Pt o 2 or Suppl B.

126

Only use Arabic numbers. For example: convert Suppl III to Suppl 3.o End issue information with a colon except when further divisions o exist.

General Rules for Location (Pagination):13. Give numbers of all the pages on which the article appears. o Do not repeat page numbers except when they are followed by a o letter. For example: 123-125 should read 123-5, but 124A-126A is correct.Include a letter (often S for Supplement or A for Appendix) when it o precedes the page number. For example: S10-8.End pagination information with a full stop. o

General Rules for Language (only if the article is not in English):14. Give the language of publication.o Capitalize the language name e.g. Spanish not spanish.o Follow the language name with a full stop.o

Do not use abstracts as a reference. If the reference applies to a paper that has been accepted but not published you should say that it is ‘in press’ or ‘forthcoming’. You should obtain written permission from the author and verifi cation that it has been accepted. If the reference applies to a paper that has been submitted but not accepted you should say in the text that it is ‘unpublished observations’, again you should obtain written permission from the author.

You should avoid citing a ‘personal communication’ except when it gives es-sential information that is not available publicly any other way. If this is the case the person’s name and the date of the communication should be cited in brackets in the text. Again, written permission and a confi r-mation should be obtained from the person writing the ‘personal com-munication’.


127


Always verify the references you make against the original documents.

Tables: All information that you give in a table should have a number and a short descriptive caption underneath. You should present the tables in the same order as the reference to them appears in the main text. You should explain all non-standard abbreviations and symbols in a footnote.If you use a table from somebody else’s work you need to get written permission and give credit for it. Write a note like this:

Adapted, with permission, from reference 12.

VISUAL DICTIONARIES

130

1

12

11

10

7 8

5

6

2

3

4

16171819

22

23 24 2526

27

28 29

30 31

32

33 34

3536

37

38

39

40

9

131415

20

21

131

VISUAL DICTIONARIES

AN

TE

RIO

RFr

onta

l reg

ion

(for

ehea

d)1.

O

rbita

l (ey

e) o

r opt

halm

ic re

gion

2.

Ora

l (m

outh

) reg

ion

3.

Axi

la (a

rmpi

t) re

gion

4.

Tho

raci

c (c

hest

)5.

C

elia

c re

gion

(abd

omen

)6.

U

mbi

lical

regi

on (n

avel

)7.

Pe

lvis

8.

Ingu

inal

regi

on (g

roin

)9.

Pu

bic

10.

Palm

ar (a

nter

ior s

ufac

e of

han

d)11

. Pe

dal r

egio

n (f

oot)

12.

Leg

13.

Pate

lla (K

nee)

14.

Fem

oral

regi

on (t

high

)15

. H

and

16.

Car

pal (

wris

t)17

. C

ubita

l reg

ion

(for

earm

)18

. B

rach

ial r

egio

n (a

rm)

19.

Mam

mar

y (b

reas

t) re

gion

20.

Faci

al re

gion

(fac

e)21

. C

rani

um (s

kull)

22.

Rig

ht u

pper

qua

dran

t23

. Le

ft u

pper

qua

dran

t24

. Le

ft lo

wer

qua

dran

t25

. R

ight

low

er q

uadr

ant

26.

POST

ER

IOR

Occ

ipita

l reg

ion

(sku

ll)27

. B

rach

ial r

egio

n (a

rm)

28.

Lum

bar

regi

on (s

mal

l of

back

) or l

oin

29.

Sacr

al re

gion

30.

Glu

teal

regi

on (b

utto

ck)

31.

Popl

iteal

regi

on (b

ack

of k

nee)

32.

Tars

al re

gion

(ank

le)

33.

Plan

tar (

sole

of

foot

)34

. C

alca

neal

(hee

l of

foot

)35

. C

alf

36.

Hip

37.

Flan

k38

. Sh

ould

er39

. C

ervi

cal r

egio

n (n

eck)

40.

Upp

er li

mb

Cep

halic

regi

on

132

115

1413

12

11

10 9

7

8

56

2

3

4

16

17 1819

20

2122

2425 26

27

28

29

3031

45

44

43

4241

40

39

37

38

35

36

32

3334

46

4748

49

50

A B CIHG

F

ED

23

133

VISUAL DICTIONARIES

Del

toid

mus

cle

1.

Pect

oral

is m

ajor

mus

cle

2.

Bic

eps

brac

hii m

uscl

e3.

V

astu

s la

tera

lis m

uscl

e4.

R

ectu

s fe

mor

is m

uscl

e5.

Te

nsor

fasc

iae

lata

e m

uscl

e6.

Pe

ctin

eus

mus

cle

7.

Gra

cilis

mus

cle

8.

Sart

oriu

s m

uscl

e9.

St

erno

clei

dom

asto

id m

uscl

e10

. In

ferio

r bel

ly o

moh

yold

11

. m

uscl

eLa

rynx

12.

Thy

roid

gla

nd13

. Tr

ache

a14

. M

anub

rium

15.

Ster

nal a

ngle

16.

Bod

y of

the

ster

num

17.

Xip

hoid

pro

cess

18.

Cos

toca

rtila

ges

19.

Falc

iform

liga

men

t20

. Le

ft lo

be o

f th

e liv

er21

.

Rig

ht lo

be o

f th

e liv

er22

. R

ight

lung

: Upp

er, m

edia

l 23

. an

d lo

wer

lobe

sH

oriz

onta

l fi s

sure

24.

Left

obl

ique

fi ss

ure

25.

Dia

phra

gm26

. St

omac

h27

. D

uode

num

28.

Urin

ary

blad

der

29.

App

endi

x30

. C

aecu

m31

. H

epat

ic fl

exur

e32

. Tr

ansv

erse

col

on33

. Sp

leni

c fi s

sure

34.

Coi

ls o

f th

e sm

all i

ntes

tine

35.

Scro

tum

36.

Fem

oral

art

ery

37.

Fem

oral

vei

n38

. In

guin

al li

gam

ent

39.

Hea

rt in

the

peric

ardi

al s

ac40

. A

ortic

arc

h41

. Su

perio

r ven

a ca

va42

.

Rig

ht c

omm

on c

arot

id a

rter

y43

. R

ight

sub

clav

ian

vein

44.

Pelv

ic s

acra

l for

amin

a45

. Sa

crum

46.

Coc

cyx

47.

Lum

bar v

erte

brae

48.

Iliac

cre

st49

. C

lavi

cle

50.

HU

MA

N A

NA

TO

MY

A.-

Rig

ht h

ypoc

hond

riac

regi

onB.

- Rig

ht lu

mba

r reg

ion

C.-

Rig

ht il

iac

regi

onD

.- E

piga

stric

regi

onE

.- U

mbi

lical

regi

onF.

- Hyp

ogas

tric

regi

onG

.- Le

ft h

ypoc

hond

riac

regi

onH

.- Le

ft lu

mba

r reg

ion

I.- L

eft i

liac

regi

on

134

115

14 1312

11

109

7

8

56

2

3

416

1718

19

20

21

22

23 2425

26

2728

29

30

31 45

44

434241

4039

37

38

35

36

32

33

34

46

47

48 4950

5152

53

54

55

56

57

58 59

60

61

65

66

62

63

64

1

2

3 6

10

57

5861

135

VISUAL DICTIONARIES

HU

MA

N A

NA

TO

MY

Hea

d of

righ

t fem

ur1.

G

reat

er tr

ocha

nter

2.

Nec

k of

fem

ur3.

In

tert

roch

ante

ric c

rest

4.

Inte

rtro

chan

teric

line

5.

Less

er tr

ocha

nter

6.

Spira

l lin

e7.

Li

nea

aspe

ra8.

La

tera

l epi

cond

yle

9.

Late

ral c

ondy

le o

f fe

mur

10.

Med

ial e

pico

ndyl

e11

. M

edia

l con

dyle

12.

Inte

rcon

dyla

r fos

sa13

. La

tera

l sup

raco

ndyl

ar ri

dge

14.

Inte

rcon

dyla

r tub

ercl

es15

. La

tera

l con

dyle

of

tibia

16.

Med

ial c

ondy

le o

f tib

ia17

. Fi

bula

r hea

d18

. T

ibia

l tub

ercl

e19

. T

ibia

20.

Fibu

la21

. In

tero

sseu

s bo

rder

s22

.

Ant

erio

r tib

ial b

orde

r (cr

est)

23.

Late

ral s

urfa

ce24

. M

edia

l sur

face

25.

Ant

erio

r bor

der

26.

Late

ral m

alle

olus

of fi b

ula

27.

Infe

rior a

rtic

ular

sur

face

28.

Med

ial m

alle

olus

or t

ibia

29.

Pate

lla30

. A

nter

ior g

lute

al li

ne31

. Tu

berc

le o

f ili

ac c

rest

32.

Ant

erio

r sup

erio

r ilia

c sp

ine

33.

Ant

erio

r inf

erio

r ilia

c sp

ine

34.

Infe

rior g

lute

al li

ne35

. Lu

nate

sur

face

36.

Ace

tabu

lar f

ossa

37.

Supe

rior r

amus

of

pubi

s38

. Pu

bic

tube

rcle

39.

Obt

urat

or c

rest

40.

Obt

urat

or fo

ram

en41

. B

ody

of p

ubis

42.

Ram

us o

f is

chiu

m43

. Is

chia

l tub

eros

ity44

. A

ceta

bulu

m45

.

Isch

ial s

pine

46.

Post

erio

r inf

erio

r ilia

c sp

ine

47.

Post

erio

r sup

erio

r ilia

c sp

ine

48.

Iliac

cre

st49

. Sa

croi

liac

join

t50

. Sa

crum

51.

Inno

min

ate

(osc

oxae

)52

. Ili

um53

. A

ceta

bulu

m54

. Pe

lvic

out

let

55.

Spin

e56

. La

min

a57

. Su

perio

r art

icul

ar p

roce

ss58

. Tr

ansv

erse

fora

men

59.

Cen

trum

(bod

y)60

. Pe

dicl

e61

. V

erte

bral

fora

men

62.

Face

t of

tube

rcle

of

rib63

. Su

perio

r fac

et fo

r hea

d or

rib

64.

Supe

rior a

rtic

ular

face

t65

. Tr

ansv

erse

pro

cess

66.

136

1

15

14

131211

109

7

8

5

623

4

16

1718

19 20

21

2223

24

25 2627

28

29

30

31

45

44

43

42

41

4039

37

3835

36

32

33 34

46

47

48

4950

5152 53 54 55

56

57

58

5960

6162

63

137

VISUAL DICTIONARIES

Hum

erus

1.

Less

er tu

bero

sity

2.

Gre

ater

tube

rosi

ty3.

H

ead

of h

umer

us4.

Lo

catio

n of

gle

noid

foss

a os

5.

sc

apul

aG

leno

id n

eck

6.

Infr

agle

noid

tube

rosi

ty a

nd

7.

ridge

Cor

acoi

d pr

oces

s8.

A

crom

ion

proc

ess

9.

Supr

asca

puar

not

ch10

. C

lavi

cle

11.

Firs

t rib

12.

Ster

nal e

nd13

. V

erte

bral

bor

der

14.

Scap

ula

15.

Subs

capu

lar f

ossa

16.

Infe

rior a

ngle

17.

Axi

llary

bor

der

18.

Man

ubriu

m19

. B

ody

20.

Xip

hoid

pro

cess

21.

Gre

ater

tube

rcle

22.

Less

er tu

berc

le23

. H

ead

24.

Inte

rtub

ercu

lar g

roov

e25

. D

elto

id tu

bero

sity

26.

Nut

rient

fora

men

27.

Late

ral e

pico

ndyl

e28

. C

oron

oid

foss

a29

. C

apitu

lum

30.

Troc

hlea

31.

Med

ial e

pico

ndyl

e32

. A

nato

mic

nec

k33

. Su

rgic

al n

eck

34.

Ole

cran

on fo

ssa

35.

Ole

cran

on p

roce

ss36

. C

oron

oid

proc

ess

37.

Rad

ial h

ead

38.

Nec

k39

. U

lnar

tube

rosi

ty40

. R

adia

l tub

eros

ity41

. U

lnar

42.

Inte

ross

eus

mem

bran

e43

. St

yloi

d pr

oces

s44

. C

arpa

l sur

face

s45

. M

etac

arpa

l46

. Pr

oxim

al p

hala

nx47

. D

ista

l pha

lanx

48.

Scap

hoid

49.

Trap

eziu

m50

. Tr

apez

oid

51.

Luna

te52

. Tr

ique

trum

53.

Pisi

form

54.

Ham

ate

55.

Cap

itate

56.

138

1

15

14

13

12

10

9

7

8

5

6

23

4

16

17

18

19

20

21

22

23

24

25

26

27

28

29

11

11

139

VISUAL DICTIONARIES

Lead

line

d w

ood

door

(rad

iatio

n pr

otec

tion)

1.

Lead

gla

ss a

nd w

arni

ng s

ign

2.

X-r

ay s

afet

y gl

ass

3.

Pillo

w &

pill

ow c

over

4.

Lead

line

d sh

eed

5.

Iv c

ontr

ast

6.

Han

dle

door

7.

(IV

US)

Int

rava

scul

ar u

ltras

ound

8.

Bal

loom

dila

tatio

n of

the

coro

nary

ves

sels

and

9.

vi

deo

mon

itor w

hich

reco

rds

the

cath

eter

iza-

tion

Cor

onar

y an

giog

ram

(an

X-r

ay w

ith ra

dio-

opaq

ue

10.

cont

rast

in th

e co

rona

ry a

rter

ies)

Prot

ectiv

e ga

rmen

ts “

know

n as

met

al”

or

11.

“lea

ds”

and

lead

gla

sses

C-A

rm /

cei

ling

susp

ensi

on12

. B

i-pha

sic

defi b

rilla

tor

13.

Floa

ting

tabl

e14

. H

ead

light

15.

Mic

roph

one

16.

Spea

ker

17.

Res

usci

tatio

n tr

olle

y18

. D

oubl

e ho

ok I

V19

. D

raw

ers

20.

Cyl

inde

r hol

ders

21.

Oxy

gen

cylin

der

22.

Infu

sion

pum

p23

. T

V m

onito

rs a

nd c

ontr

ol c

art

24.

Imag

e in

tens

ifi er

tow

er25

. X

-ray

tube

26.

Rot

ate

lock

27.

Func

tion

cont

rols

28.

Car

diov

ascu

lar w

ires

and

sten

ts29

.

140

1

15

14

13

12

1110

97

5

6

2

3

4

16 17

18

19

20

22

23

24

25

2726

28

29 45

4443

42

41

40

39

37

38

35

36

32

33

34

46

21

3031

47

141

VISUAL DICTIONARIES

Drip

1.

Stet

hosc

ope

2.

Ear

tips

3.

Che

stpi

ece

4.

Dia

phra

gm5.

B

ell

6.

Bin

aura

l7.

To

ngue

dep

ress

ors

8.

Tong

ue d

epre

ssor

s9.

D

iagn

ostic

oto

scop

e10

. H

andl

e ot

osco

pe11

. O

tosc

ope

& o

phth

alm

osco

pe

12.

char

ger

Oph

thal

mos

cope

13.

X-r

ay b

ox14

. X

-ray

fi lm

15.

T16

. ay

lor r

efl e

x ha

mm

erQ

ueen

s refl e

x ha

mm

er17

. Pa

tella

ham

mer

buc

k18

.

Oxy

gen fl o

wm

eter

19.

Oxy

gen

hum

idifi

catio

n ch

ambe

r20

. V

acuu

m h

ose

21.

Vac

uum

wal

l - m

ount

ed

22.

outle

t soc

ket

Vac

uum

pre

ssur

e re

gula

tor

23.

Vac

uum

rese

rvoi

r/su

ctio

n 24

. re

sevo

ir.B

ram

ber h

ead

mirr

or25

. M

agill

end

otra

chea

l for

ceps

26.

Har

tman

n cr

ocod

ile fo

rcep

s27

. N

oots

ear

tank

28.

Dou

ble

side

d ey

e ch

art

29.

Wax

hoo

k30

. Jo

bson

hor

ne ri

ng p

robe

31.

Gra

efe

eye

spec

ulum

32.

Cas

trov

iejo

nee

dle

hold

e33

. R

yder

nee

dle

hold

er34

.

Shee

t35

. M

edic

al c

ouch

36.

E.N

.T. e

xam

cha

ir37

. Pr

ojec

tor

38.

Shel

ve39

. E

ye d

rops

40.

Chi

n re

st41

. A

djus

tabl

e in

stru

men

t tab

le42

. Sl

it la

mp

lens

e43

. In

dire

ct s

urgi

cal l

ense

44.

Slit

lam

p m

icro

scop

e45

. B

inoc

ular

mic

rosc

ope

46.

Slit

illum

inat

or47

. Sl

it Ill

umin

ator

48.

142

21 23

1

1514

13

12

11

10

9

7

8

56

2

3

4

16

17

1920

22

242526

27

28

29

3018

143

VISUAL DICTIONARIES

Coo

mas

sie

blue

1.

Clo

ning

cyl

inde

rs2.

H

and

held

ele

ctro

nic

colo

ny c

ount

er3.

B

lood

cul

ture

sys

tem

4.

Petr

idis

h st

and

5.

Cle

ar P

etri

dish

es6.

W

heat

on b

urne

r7.

Sh

arp

Box

8.

Stai

nles

s st

eel a

ssay

fauc

et9.

Si

nk10

. C

entr

ifuge

box

11.

Mic

rosc

ope

12.

Slid

e ra

ck13

. Sl

ides

14.

Safe

ty c

abin

et15

.

Glo

ves

16.

Wid

e fi e

ld e

yepi

eces

17.

Gra

m s

tain

set

s18

. O

xfor

d pl

atin

um in

ocul

atio

n lo

op19

. C

ell c

ultu

re p

late

s20

. C

hann

el m

icro

pipe

ttes

21.

Erle

nmey

er fl

asks

22.

Funn

el23

. G

lass

gra

duat

ed c

ylin

der

24.

Test

tube

rack

25.

Test

tube

s26

. C

ham

bere

d sl

ides

27.

Pipe

ttes

28.

Dis

posa

ble

poly

styr

ene

curv

ette

stir

ring

spat

ula

29.

Slop

ed s

houl

der p

last

ic w

ash

bottl

e30

.

144

1

15

14 13

12

11

9

7

8

62

3

4

16

17

18

19

1

15

14

13

12

1110

97

8

5

6

2

34

1617

1819

20

11

5

10

10

145

VISUAL DICTIONARIES

AN

AE

STH

ET

IC M

AC

HIN

E

Wal

l - m

ount

ed o

utle

t soc

ket

1.

Col

our -

cod

ed h

oses

2.

Out

let s

ocke

ts m

ount

ed in

a re

trac

tabl

e ce

iling

3.

un

itFl

owm

eter

4.

Con

trol

Kno

b5.

Ta

pere

d tu

be6.

B

obbi

n7.

E

CG

/BP/

Satu

ratio

n/Pu

lse

rate

8.

Circ

uits

9.

Vap

oriz

ers

10.

Suct

ion

11.

CO

12.

2, O

2, N

2O m

onito

r and

insp

irato

ry/e

xpira

-to

ry g

ases

Ven

tilat

or13

. V

entil

ator

bel

low

s14

. Pr

essu

re g

auge

15.

Para

llel c

ircui

t16

. Fa

il sa

fe m

onito

rs17

. E

mer

genc

y ox

ygen

fl us

h bo

tton

situ

ated

bel

ow

18.

the fl o

wm

eter

sB

ag19

.

AN

AE

STH

ET

IC E

QU

IPM

EN

T

A ra

nge

of d

iffer

ent s

ized

lary

ngea

l mas

ks (L

M)

1.

Ran

ge o

f or

opha

ryng

eal (

Gue

del)

airw

ays

2.

Cuf

fed

nort

h-fa

cing

nas

al R

AE

tube

(far

left

)3.

U

ncuf

fed

paed

iatr

ic tr

ache

al tu

bes

(cen

tre

nigh

t)4.

So

uth-

faci

ng o

ral R

AE

(Far

righ

t)5.

Pi

lot b

allo

on6.

Se

lf -

seal

ing

valv

e7.

C

uff

8.

Rad

io-o

paqu

e lin

e9.

15

mm

. con

nect

or10

. N

asop

hary

ngea

l airw

ays

11.

Safe

ty p

in (p

reve

nt th

e ai

rway

from

mig

ratin

g 12

. in

to th

e no

se)

Lary

ngos

cope

(han

dle

and

a bl

ade)

13.

Lary

ngos

cope

bul

b14

. E

ndot

rach

eal t

ubes

15.

Cuf

f (a

n el

liptic

al c

uff

at th

e di

stal

end

)16

. B

ars

or s

lits

(The

se p

reve

nt e

pigl

ottis

from

obs

-17

. tu

ctin

g th

e lu

men

)A

rter

ial c

annu

lae

18.

Perip

heni

al v

ia (V

enfl o

n)19

. E

pidu

ral c

athe

ter a

nd e

pidu

ral fi

lter

20.

146

1

1514

131211

109

7

56

2

3

4

16

17

18

19

20

21

19

11

8

147

VISUAL DICTIONARIES

Surg

ical

glo

ves

1.

Clo

sed

rese

rvoi

r bag

2.

T-pi

ece

3.

Bre

athi

ng s

yste

m fi

lter

4.

Face

-mas

k5.

Si

de s

trea

m C

O6.

2 a

naly

ser

Bis

mon

itorin

g7.

M

aple

son

B b

reat

hing

sys

tem

8.

APL

val

ve9.

In

let f

resh

gas

fl ow

10.

Lam

inar

fl ow

sys

tem

11.

Scru

b si

nk12

. H

ospi

tal t

ap13

. O

pera

ting

tabl

e14

. A

rm re

tain

er15

. A

naes

thet

ic S

cree

n16

. D

ough

nut h

eadr

ing

adul

t17

. Ll

oyd

Dav

ies

stirr

ups

with

pad

s18

. O

pera

ting

thea

tre

light

s (la

mp

head

)19

. Li

ght a

rms

20.

Supp

hier

arm

21.

148

1

12

11

10

9

7

8

56

2

3

4

1

ba1211

10

9

7

8

5

6

23

4

1

11

109

7 8

5

6

2

3

4

149

VISUAL DICTIONARIES

PRO

CT

OSC

OPY

/SIG

MO

IDO

SCO

PY S

ET

Ligh

t sou

rce

1.

Han

dle

2.

Switc

h3.

Pr

otos

cope

(adu

lt)4.

Li

ght a

ttach

men

t5.

Pr

otos

cop

(pae

diat

ric)

6.

Bel

low

s7.

E

yepi

ece

(lens

)8.

Li

ght l

ead

9.

Bio

psy

forc

eps

10.

Rig

id s

igm

oido

scop

es11

.

GA

STR

OSC

OPY

SE

TLi

ght s

ourc

e1.

H

andl

e2.

B

iops

y fo

rcep

s3.

M

outh

gua

rd4.

T

ip c

ontr

ol le

ns5.

A

ir/su

ctio

n6.

B

iops

y ch

anne

l7.

A

ir-fe

ed c

onne

ctor

8.

Suct

ion

9.

Wat

er b

ottle

(air

feed

sys

tem

)10

. Sw

itch

11.

Fibe

r opt

ic g

astr

osco

pe12

.

LAPA

RO

SCO

PIC

SU

RG

ERY

10 m

m. t

roch

ar1.

V

eres

s ne

edle

2.

Has

son

troc

har

3.

“S”

refr

acto

rs4.

5m

m. g

rasp

er5.

5m

m. i

nstr

umen

ts6.

La

paro

scop

ic s

ciss

ors

7.

a) D

esig

ned

as c

urve

db

Des

igne

d as

hoo

ked

Lase

r fi b

re8.

La

ser s

calp

el9.

Ir

rigat

or/a

spira

tor

10.

10 m

m. c

law

gra

sper

11.

10 m

m. s

poon

forc

ep12

.

150

1

15

14

13

12

11

109

7

8

56

2

3 416

17

1

12

1110

9

7

85

6

2

3

4

151

VISUAL DICTIONARIES

TO

ILE

TS

Exi

t1.

A

larm

sw

itch

2.

Han

ddra

yer

3.

Tap

4.

Sink

5.

Plug

6.

Com

b7.

Si

nk d

rain

age

8.

Sock

et9.

To

ilet s

oap

10.

Mirr

ow11

. Sh

ower

12.

Tow

el13

. R

azor

bla

de14

. Sh

avin

g so

ap15

. B

ath

gel

16.

Wor

ktop

17.

CH

AN

GIN

G R

OO

MFl

uore

scen

t lig

hts

1.

Cei

ling

2.

Air

cond

ition

ing

cond

ucts

3.

Win

dow

4.

Rac

k5.

B

ench

6.

Fire

-ala

rm7.

Lo

ck8.

C

logs

9.

Coa

t hoo

k10

. D

irty

clot

h tr

olle

y11

. W

heel

s12

.

152

1

15

1413

12

11

10

9 7

8

5

6

2

3

4

16

17

18

19

20

21

232425

26

2728

29

30

31

22

153

VISUAL DICTIONARIES

ME

DIC

AL

SEC

RE

TA

RIE

SH

and

bag

1.

Stap

ler

2.

Stap

les

3.

Boo

kend

4.

File

sor

ter

5.

Des

k m

at6.

C

lipbo

ard

7.

Des

k tid

ie8.

Po

st-it

9.

Env

elop

e10

. H

ole

punc

h/or

per

fora

tors

11.

Cal

enda

r12

. So

ft d

rink

13.

Scis

sors

14.

Rub

ber s

tam

p15

. T

ip-e

x16

. C

lear

tape

17.

Lette

r try

18.

Flat

rul

er19

. M

ouse

20.

Mec

hani

cal p

enci

l21

. C

lip22

.

Pins

23.

Key

boar

d24

. M

onito

r25

. N

ote-

book

26.

Tele

phon

e27

. A

nsw

er m

achi

ne28

. D

icta

tion

mac

hine

29.

Secr

etar

y30

. M

obile

pho

ne31

.

154

1

15

14

13

12 11

10

978

5

6

234

16

17

155

VISUAL DICTIONARIES

Ost

eoto

mes

1.

“T

Han

dle”

for r

eam

ers

2.

Fem

oral

ream

ers

3.

Rob

ert J

ones

ele

vato

r4.

V

olkm

an s

poon

5.

Sur

gica

l gal

lipot

6.

Bon

e cu

tter

7.

Bris

tol’s

per

iost

eal e

leva

tors

8.

Ass

orte

d ha

emos

tatic

clip

s9.

B

one

leve

rs10

. A

ceta

bula

r cup

intr

oduc

er11

. Sp

oons

for a

ceta

bulu

m/f

emor

al re

cons

truc

tion

12.

Ace

tabu

lar s

izer

s13

. Im

pact

er14

. C

urre

tte15

. R

eam

ers

16.

Par

ts o

f C

harn

ley

retr

acto

r 17

.

156

115

14

13

12

11

109

7

8

5

62

3

4

16

17

18

19

20 21

10

18

11

157

APLICATION FORMS

AU

STIN

MO

OR

E S

ET

Fem

oral

hea

d ga

uge

1.

Box

chi

sel

2.

Fem

oral

ream

er3.

E

xtra

ctor

for r

emor

al o

f 4.

A

ustin

Moo

re p

rost

hesi

sM

urph

y’s s

kid

(to le

ver

5.

acet

abul

um in

)To

mm

y ba

r6.

C

orsc

rew

for r

emor

al o

f 7.

fe

mor

al h

ead

Fem

oral

ream

ers/

rasp

ers

8.

ME

NIS

EC

TO

MY

SE

TR

ampl

ey´s

spo

nge

forc

eps

9.

Lang

enbe

ck re

trac

tors

10.

Tow

el c

lips

11.

Koc

her’s

forc

eps

12.

May

o sc

isso

rs13

. B

lunt

hoo

k14

. Sm

illie

s K

nive

s15

. K

nife

han

dles

16.

ME

NIS

EC

TO

MY

SE

TB

one

cutte

r17

. B

one

nibb

lers

18.

Vol

kman

spo

on19

. Su

rgic

al g

allip

ot20

. Su

rgic

al B

owls

21.

158

1 15

1413

12

1110

9

7

8

5

6

2 3 4

16

17

1819

20

2122

23

2425

26

27

2829

30

31

4140

39

373835 36

3233

34

37

36

35

38

159

VISUAL DICTIONARIES

Obt

urat

or1.

V

isua

l obt

urat

or (s

heat

h)2.

te

lesc

ope

goes

dow

n th

e m

iddl

eR

esec

tosc

ope

(inne

r she

ath)

3.

Rec

tosc

ope

(out

er s

heat

h)4.

In

sula

ted

5.

Dia

ther

my

lead

con

nect

ion

6.

Long

fl ex

ible

gra

spin

g 7.

fo

rcep

s(s

tone

gra

spin

g)Te

lesc

ope

for u

rete

rore

nos-

8.

cope

Ligh

t inl

et9.

Sh

eath

for u

rete

rore

nosc

ope

10.

(tele

scop

e pa

sses

dow

n th

e m

iddl

e)In

let c

hann

el11

. W

ater

inle

t12

.

Shor

t ure

tero

reno

scop

e13

. In

let c

hann

el14

. Te

lesc

ope

15.

Ligh

t Sou

rce

16.

Elli

ck e

vacu

ator

17.

(to w

ash

out t

he b

ladd

er &

bi

ts)

Dia

ther

my

lead

con

nect

ion

18.

Ope

ratin

g ha

ndle

with

loop

19

. in

sert

edE

yepi

ece

20.

Ligh

t inl

et21

. W

ater

in22

. W

ater

out

23.

Bot

h sh

eath

s in

terlo

cked

24.

Vis

ual o

btur

ator

25.

Turn

er-w

arni

ck n

eedl

es26

. N

eedl

e w

ith a

pre

-load

ed

27.

sutu

re

Dor

mia

bas

ket

28.

(blu

nten

d &

fi lif

orm

tip)

Filif

orm

tip

(fl at

wire

s)29

. Se

gura

bas

ket

30.

Slid

e op

erat

ed b

y ha

ndle

s31

. O

btur

ator

32.

Wat

er o

utle

r33

. Li

ght (

tele

scop

e). S

tone

34

. pu

nch

Wat

er in

let

35.

Ligh

t sou

rce

36.

Eye

piec

e37

. in

stru

men

t inl

et38

.

Bio

psy

forc

eps

39.

0º T

eles

cope

40.

(use

d w

ith b

iops

y fo

rcep

s)25

º Tel

esco

pe41

. (u

sed

for u

reth

rosc

opy)

Stone punch Nephroscopes Cystoscope

160

1

1514

1312

11

10

8

5 3

97

6

2

4

1617

1

14

13

1211

10

9 7

5

6

2

34

8

1

161

VISUAL DICTIONARIES

LAPA

RO

TO

MY

SE

TM

osqu

ito a

rter

y fo

rcep

s, (o

n pi

n) c

urve

d1.

Su

cker

s2.

D

iath

erm

y ca

ble

3.

Mor

ris re

trac

tor

4.

Lang

enbe

ck re

trac

tors

5.

Dea

ver r

etra

ctor

s6.

K

elly

retr

acto

r7.

G

ollig

her r

etra

ctor

8.

Cro

ss-a

ctio

n to

wel

clip

s9.

B

acha

us to

wel

clip

s10

. D

ebak

ey d

isse

ctin

g fo

rcep

s11

. Fi

ne-t

ooth

ed d

isse

ctin

g fo

rcep

s12

. C

harn

ley

toot

hed

diss

ectin

g fo

rcep

s13

. Sp

ence

r Wel

ls fo

rcep

s (o

n pi

n)14

. M

ayo

arte

ry fo

rcep

s15

. A

lliss

tiss

ue fo

rcep

s (o

n pi

n)16

. B

adco

ck ti

ssue

forc

eps

(on

pin)

17.

CA

RD

IOVA

SCU

LAR

SE

TTr

aver

s re

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NON GOVERNMENTAL ORGANIZATIONS

4x4 Solidario Madrid-Tifaritiwww.4x4solidario.blogspot.com. Tel: (+34) 913600514.Santa Maria 14-16. 28014 Madrid. Spain.This is a great Spanish charity based in Madrid. They organ-ise trecks by 4x4 from Madrid to Tifariti (refugee camps), covering around 3500 km and bringing humanitarian sup-

port to the Saharaui people; from hospital recruitment to educational material. You can work as a doctor or as a health worker in different ways. Do not miss this opportunity!

ACORD(Agency for Cooperation and Research in Development) is an Africa-led international alliance working to promote social justice - www.acord.org.uk. Dean Geadley House, 52 Horseferry Road, London SW1P 2AF. Tel: 020 7227 8600. Fax: 020 7799 1868 – Acord has offi ces in and sends volunteers to: Angola, Botswana, Burkina Faso, Burundi, Chad, the Congo, Eritrea, Ethiopia, Guinea, Liberia, Mali, Mauritania, Mozam-bique, Namibia, Rwanda, Somalia, the Sudan, Tanzania and Uganda.

Action Against Hunger - www.aah-uk.org. First Floor, rear premises, 161-163 Greenwich High Road, London, SE10 8JA. Tel: 0208 293 6190. Email: [email protected] against hunger provides relief and development to over 40 coun-tries (including parts of Africa, South America and Russia). They offer one-year contracts which include food, travel and accommodation ex-penses, as well as an allowance. Nutritionalists, doctors and nurses are often required.

4 x 4 Solidario

Madrid - Tifariti

2009

www.4x4solidario.blogspot.com

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ActionAid www.actionaid.org International head offi ce: PostNet suite #248. Private bag

X31. Saxonwold 2132. Johannesburg. South Africa. Tel: +27 11 731 4500. Fax: +27 11 880 8082 - [email protected]. (They also have offi ces in Guatemala, Thailand, Zimbabwe and the USA – see website). Action Aid provides help to some of the poorest countries in Africa, South America and Asia.

Action on Disability and Development www.add.org.uk e-mail: [email protected] Vallis House, 57 Vallis Road, Frome,

Somerset, BA11 3EG. Tel: 01373 473064. Fax: 01373 452075. ADD is a UK-based agency that works with disabled people in 12 of the poorest countries in Africa and Asia.

Action Health – has now been incorporated into Skillshare (see below). Action Partners Ministries www.actionpartners.org.uk Bawtry Hall, Bawtry, Doncaster DN10 6JH. Tel: 01302 710750. Fax: 01302 719399. This is a small Christian organization that has links wih many hospitals in Africa (Cameroon, Chad, Egypt, Kenya, Ghana, the Congo, the Sudan and Nigeria). Most of their work concerns rural development, however, there are often places available for doctors and nurses.

Africa Evangelical The Africa Evangelical Fellowship provides mis-sions to: Angola, Botswana, Malawi, Mozambique, Namibia, South Af-rica, Swaziland, Tanzania, Zambia, Zimbabwe and the Islands of Mada-gascar, Mauritius and Reunion. Africa Evangelical Fellowship.P.O. Box 411167. Charlotte, NC 28241-1167. (803) 548-0755. Fax (803) 548-0885. [email protected].

Africa Inland Mission - www.aim-us.org or www.aim-eur.org . Halifax Place, Notting-ham NG1 1QN. Tel: 020 7281 1184. Fax:

020 7281 4479. AIM is a missionary organization that runs a number of missionary hospitals in 13 countries in Africa including: Angola, Central

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African Republic, Comores, Chad, the Congo, Kenya, Lesotho, Mada-gascar, Mayotte, Mozambique, Namibia, Seychelles, the Sudan, Tanzania and Uganda. Previously, they have been very good at aranging short term placements and electives.

Agency for Personal Service (APSO) www.apso.ie APSO Head offi ce, Bishops Square, Redmonds Hill, Dublin 2, Ireland. Tel: (353-1) 4789400. Fax: (353-1)4751006 This is the central organization for all of Ireland’s NGOs. They can provide information on work throughout Africa and Central America.

American Refugee Committee www.archq.org 2244 Nicolette Av-

enue, Suite 250, Minneapolis MN 55404, USA. Tel: +1 612 872 7060. Fax: +1 612 872 4309. They can provide information on work throu-ghout America and Central America.

African Medical and Research Foundation (AMREF) www.amref.org. 11, Old Queen Street, London SW1H 9LA. AMREF is based In Nairobi and has country offi ces in Kenya, Uganda, Tanzania and South Africa. There are fi eld offi ces in Mozambique and Ethiopia and major programmes in South Sudan, Somalia and Rwanda. AMREF’s priority intervention areas are: HIV/AIDS, TB, sexually transmitted diseases, malaria, water and basic sanitation, disaster management and response, family health, clinical outreach services to remote areas, development of health learning materials, training and undertaking of consultancies.

Asociación Amigos del Pueblo Saharaui de MadridC/ Pez, nº 27-Bajo. 28004 Madrid (Madrid) . Tlfno. 915 218 166. Fax. 915 210 512. [email protected]

Asociacion Mensajeros de la PazPza General Vara de Rey 28005 Madrid (Madrid) Tlfno. 913 643 940. Fax. 913 643 [email protected]

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Australian Volunteers International www.oz-vol.org.au. 71 Argyle Strett, PO Box 350, Fitzroy, Victoria 3065 Australia. Tel: +61 3 9279 1788. Fax: +61 3 9419 4280 Australian Volunteers In-ternational (as its name implies) sends Australian Volunteers to over 50 developing countries. It also

sends volunteers to remote Aboriginal settlements throughout Australia. Volunteers have to be Australian, at least 20 and have at least two years previous work expereince. Posts are usually for a minimum of two years and are salaried at a level comprable to local wages at your destination hence food and lodging should be covered.

Baptist Missionary Society www.bms.org.uk PO Box 49, Bap-tist House, 129 Broadway, Didcot, Oxon OX11 8XA. Tel: 01235 512 077. Fax: 01235 511 265. The Baptist Missionary Society have a variety of posts, but most useful to readers will be the short term medical posts. You are usually required to pay to-

wards working with them, however, costs are reasonable. Check website for current availablility.

British Executive Service Overseas (BESO) www.beso.org e-mail: [email protected] Vauxhall Bridge Road, London SW1V 2RB. BESO works in 146 coun-tries providing professional expertise to other organisa-

tions. Medics of all descriptions are often required. There are no upper or lower age limits.

British Council www.britishcouncil.org Bridgewater House, 58 Whitworth Street, Manchester M1 6BB. Tel:

+44 (0)161 957 7755. Fax +44 (0)161 957 7762. This British Council serves to form connections with people worldwide. Their website pro-vides many links.

British Nepal Medical Trust www.bnmt.org.np 130

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Vale Road, Tonbridge, Kent TN9 1SP. Tel: 01732 360284. Fax: 01732 363876. Working in the eastern region of Nepal, BNMT implements, in close collaboration with the government, three major programmes: • TB and leprosy control and management • essential drugs supply and rational use • community health and development.

CAFOD (http://www.cafod.org.uk/jobs/head-offi ce) 2 Romero Close, Stockwell Road, London SW9 9TY. Cafod works with partners overseas but does not send people directly.

Calcutta Rescue Fund www.calcuttarescue.nl PO Box 16163, Clapham, London SW4 7ZT. Tel: +44 1483 440941. Fax: +44 1483 573184. This organisa-tion was set up by Dr Jack Preger, a British Nation-al who has made working in Calcutta his life’s work.

Nurses, pharmacists, physiotherapists and podiatrists are required with a minimum of 12 months commitment.

CARE International UK http://www.careinternational.org.uk/CARE International UK, 10-13 Rushworth Street. London. SE1 0RB. United Kingdom. Tel: +44 (0)207 934 9334. Fax: +44 (0)207 934 9335CARE is a very large relief organisation concentrating on Africa, South America, Asia and Eastern Europe. It only takes professionals with ex-tensive experience in the areas that are relevant to their current projects. Three years of professional experience in a developing country and a Masters in public health or diploma in Tropical Medicine and Hygiene are also often required.

Catholic Institute for International Relations www.ciir.org Unit 3, Can-onbury Yard, 190a New North Road, London N1 7BJ. Tel: +44 (0)20 7354 0883. Fax +44 (0)20 7359 0017 The CIIR has a subsection entitled Interna-tional Cooperation for Development. This is a skill share programme which

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provides health care, and other workers to around eleven developing coun-tries in Africa, South America, the Caribbean and the Middle East. This in-cludes, doctors, nurses, physios, OTs , pharmacists and midwives. You must be two years post-qualifi cation and contracts are usually for 2 years.

Catholic Medical Mission Board www.cmmb.org 10 Wset 17th Street, New York, New

Yourk. Tel: +1 212 242 7757. Fax: +1212 807 9161. CMMB is an Ameri-can organization that places U.S. and Canadian doctors and nurses in Catholic Mission hospitals in Africa, South America, Eastern Europe, the Caribbean and Papua New Guinea. Posts can be from 1 month to 2 years and the amount of assistance is proportional to the length of the contract.

Catholic Network of Volunteer Services www.cnvs.org - This organisation runs an ex-cellent website that informs volunteers about

many vaccancies in a number of catholic organisations. Jobs in Africa and South America for doctors, surgeons and nurses are often listed.

Children’s Aid Direct www.cad.org.uk. 6-8 Crown Street, Reading, Berks RG1 2SE. Tel: 0118 584 000. Fax: 0118 958 1230

Christian Aid www.christian-aid.org.uk. Christian Aid works with many partner organizations over-seas. Box 100, London SE1 7RT. [email protected]. Tel 020 7620 4444. Fax 020 7620 0719

Christian Medical Fellowship www.cmf.org. PO Box 5198 Tyger Valley Bellville 7536, Western Cape South Africa.Tel (Intl): (+27) 21 949 5199 | Fax (Intl): (+27) 86 670 1849. They also run HealthServe on www.healthserve.org

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Christian Outreach Relief and Development (CORD) www.cord.org.uk 1 New Street, Leamington Spa, Warwicks CV31 1HP.UK. Tel: 01926 315301. Fax: 01926 885786. General enquiries: [email protected] Human Resources: [email protected] currently works in Afghanistan, Cambodia, Mozambique, Rwanda, Tanzania, Vietnam and Zambia. They require committed Christians for (initially) one year. All types of health professional are required. Accommodation, expenses and a small salary are usually pro-vided.

Christians Abroad www.cabroad.org.uk 1 Stockwell Green, London

SW9 9HP. Tel: 020 7346 5951. Fax: 020 7346 5955. Christians Abroad have a number of vacancies. Accomodation, transport and a small local salary are usually provided. The site is also home to the World Service Enquiry - a database of overseas workers. A monthly listing of overseas jobs (Opportunities Abroad) is also published.

Christoffel Blindenmission (CBM) www.cbmi.de Orwell House, Cowley Road, Cambridge CB4 4WY or Nibelungenstrasse 124, D-6140 Bensheim 4, Germany. Tel: +48 62511310. Fax: +49 6251131165. CBM is a Ch-

risian organisation that prevents and treats blindness and rehabilitates the disabled in around 100 developing countries. Because of this mission they tend to recruit ophthalmologists, orthopaedic surgeons and physi-otherapists for a minimum of two years.

Church of Scotland World Mission www.churchorscot-land.org.uk 121 George

Street, Edinburgh EH2 4YN. Telephone: 0131 225 5722

Church Missionary Society (CMS) www.cms-uk.org Partnership House, 157 Waterloo Road, London SE1 8UU. Tel: 020 7928 8681. Fax: 020 7401 3215. CMS have many

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opportunities for Chrisians over 18 years of age. Missions can be from three weeks to six years and all kinds of volunteers (doctors, nurses, teachers, accountants…) are required.

Colegio Medico del Peru http://www2.cmp.org.pe/content/view/346/151/. Av. Malecón Armendáriz 791, Distrito de Mirafl ores, Lima, Perú. Lima 18.(511) 213-1400.

Commonwealth Society for the Deaf Our Mission: “Sound Seekers works in partnership with developing countries in the Commonwealth to increase

awareness of, and assist in, the prevention and treatment of deafness among children email: [email protected]. tel: 020 7233 5700. fax: 020 7233 5800- 34 Buckingham Palace Road. London. SW1W 0RE.

Concern Universal www.concern-universal.org Con-cern Universal supports initiatives that improve the daily lives of people living in some of the world’s

poorest communities - for instance, providing greater income earning opportunities, improved health care, or a clean water supply. Concern Universal, 21 King St, Hereford, HR4 9BX. Charity number 272465. Tel: +44 (0) 1432 355111. Fax: +44 (0) 1432 355086. E-mail: [email protected] . Concern Universal works in a number of coun-tries in South America and Africa.

Concern Worldwide UK www.concern.ie 47 Freder-ick Street, Belfast BT1 2LW or 52-55 Camden Street Dublin 2, Ireland or 248-250 Lavender Hill, London

SW11 1LJ. Tel: 020 7738 1033. Fax: 020 7738 1032. Concern Worldwide provides both emergency relief and long term development projects to over 20 countries including: Angola, Afghanistan, Burundi, Bangladesh, Cambodia, the Congo, East Timor, Ethiopia, Haiti, Honduras, India, Kosovo, Laos, Liberia, Mozambique, North Korea, Rwanda, Sierra Leo-

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ne, Somalia, Tanzania and Uganda. Applicants must be at least 21 with 18 months of post-qualifi cation work experiencee. Contracts can be 3-6 months for emergency relief situations, or up to 2 years for longer term projects.

Consejo Interhospitalario de Cooperación (CIC). C/ Aribau nº 25, Entlo. 4ª. 08011. Bar-celona (Barcelona). Mail: [email protected]: www.ong-cic.org

Culture Coonexions. Through Culture Connexions (CCX) SIM is committed to strengthening the local church to reach its increasingly culturally diverse neighbourhoods. They seek to place missionaries within churches in Cana-da. Missionairies may come from the local church or from around the world. www.sim.org

CUSO www.cuso.org 400-2255 Carling Avenue, Ottawa, Ontario K2B 1A6, Canada. Tel: +1 613 829 7445. Fax: +1 613 829 7996. CUSO supplies

Canadian volunteers to Africa, Asia, South America and the Caribbean and to local projects in Canada itself. A salary to cover living expenditure at your destination is provided, as well as insurance and a lump-sum re-settlement payment. Usually, only Canadians can volunteer.

Department for International Development (DFID) www.dfi d.gov.uk Abercombie House, Eaglesham Road, East Kilbride G75 8EA or 94 Victoria Street, London SW1E 5JL. Tel: 020 7917 0107. Fax: 020 7917 0174. DFID does not actually place volunteers overseas though their web site has a number of useful links.

Ecuador volunteer

Their main objective is to establish a system of selection of both national and

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international volunteers to help private and governmental organizations carry out social, cultural, educational, scientifi c and developmental activities that result in the social improvement of Ecuador and of any other country that may need help. Yánez Pinzón N25-106 y Av. Colón. Quito - Ecuador. South - América. Telf: +593 2 2557749. Telefax: +593 2 2226544. Email: [email protected]

Edinburgh Medical Missionary Society www.emms.org 7 Washington Lane, Edinburgh, EH11 2HA. Tel: 0131 313 3828. Fax: 0 131 313 4662. The EMMS have links with hospitals in Africa, Asia and South America. They have previously been very good at helping with electives.

EDUCATIONAL FOUNDATION. 4 Buxton Close. Edmonton Green. London. N9 0XL. Phone: (+0044)-(0) 20 8803-1531. E-mail: [email protected]. This is a charity dedicated to the education of children as a way of fi ghting poverty. It is run by Dr Gargesh, an Indian Consultant Anaesthetist based in England who has dedicated his whole life to others.

The charity works primarily in India, but also has some projects for Pal-estinian children in refugee camps in the Middle East. I have to say that I know this charity personally and that it is run by an honest man who is doing very valuable work for the future of the kids though the educa-tional programs.This is, without a doubt, one of the best charities I have never known.

Emmanuel Hospital Association www.eha.org.ukEuropean Fellowship, PO Box 43, Sutton SM2 5WL. Con-tact Mr Paul East. Head Offi ce: 808/92 Deepali Building, Nehru Place, North Delhi 19, India. Tel/Fax: +91 11 643

2055. EHA provides health care via 19 hospitals and 27 community projects across Northern India. The provision of basic needs and skills such as hygiene and literacy are an intergral part of their projects. They

EC(ccGE

Th h i k

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recruit most medical and surgical specialities as well as dentists, nurses, other health care workers and non-medical people such as architects, teachers, accountants and builders. Contracts are for 6 months to 2 years and an allowance to cover living costs in India is provided. The volunteer has to pay any travel costs.

Flying doctors The African Medical and Research Foundation (AMREF) PO Box 27691-00506. Nai-robi, Kenya. Fax: +254 20 609 518. Tel: +254 20 699 3000 or if you know the extension of the per-son you’d like to contact, replace the ‘000’ with the extension. AMREF is an international African or-

ganisation headquartered in Nairobi, Kenya. It has 50 years experience in health development. In 1957, three surgeons founded the Flying Doctors Service of East Africa, laying the foundation for what is now one of the continent’s leading health development and research organisations. Today, AMREF implements its projects through country programmes in Kenya, Ethiopia, Uganda, Tanzania, Southern Sudan and South Africa. Training and consulting support are provided to an additional 30 African countries. AMREF’s vision is ‘Better Health for Africa’.

Fontilles - Fighting leprosy. Plaza de Tetuán nº 6 Bajo. 46003. Valencia (Valencia). Mail: [email protected]. Web: www.fontilles.org. Tlfno. 963 511 583. Fax. 963 511 187

Goal UK www.goal.ie c/o Mean Road, London W3 8AN or PO Box 19, Dun Loaghaire, Co Dublin, Ireland. Tel: +252 1 280 9779. Fax: +353 1 280 9215.

Global Volunteer Network www.volunteer.org.nz They place volunteers in com-munity projects in China,

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Ecuador, Ghana, Nepal, New Zealand, Romania, Russia, Thailand, and Uganda. Volunteers have the opportunity to participate in a variety of educational, environmental and community aid programs. Examples of the exciting and rewarding activities available to volunteers include teaching English, environmental work, AIDS education, and assisting in an orphanage. Their Uganda and Nepal programs allow volunteers to participate in community health projects; both programs require a medical background, and are a good way for medical students to gain experience and to contribute to the global community. Phone: +64 4 569 9080 Fax: +64 4 569 9081

Halo Trust www.halotrust.org PO Box 7905, Thornhill, DG3 5WA. Fax: 01848 331122. The Halo Trust specialise in mine clearance. Specialist personnel only are required.

Handicap International www.handicap-interna-tional.org 14 Avenue Bethelot, 69361 Lyon, France. Tel: +334 78697979. Fax: +334 7869 7994.

Hands Around the World www.handsaroundtheworld.org.uk PO Box 25. Coleford, Gloucestershire GL16 7YL. Tel: +44 (0)1594 560223. HATW specialise in sending individuals to provide help in developing countries.

Health Aid www.health-aid.org [email protected] Health Aid is a public health oriented project whose aim is to im-prove the health situation of a selected community in the north of Ghana, a developing country in Africa. HEALTH-

AID wants to create a health post, to be run by local staff with a doctor as an overseer, in collaboration with Italian volunteers and other health workers. The project will educate the communities of Saboba and Chere-poni abouth hygiene and health problems in general. Medical students and doctors are welcome and expenses (except fl ights) are paid for. Projects last 5 weeks. via B. Cortinovis, 43 - 24060. Costa di Mezzate (BG) Italia . cell. 338 2905699. Tel and Fax +39 36 338 290 5699.

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Healthnet International www.healthnetinternational.org Singel 540, 1017 Amsterdam, Netherlands. Tel: +31 20 512 0640. Fax: +31 20 420 1503. Healthnet is a Dutch organization that sends volunteers to areas of chronic

crisis and post-confl ict situations.

Health Unlimited www.healthunlimited.org Prince Consort House, 27–9 Albert Embank-ment, London SE1 7TS. Tel: 020 7582 5999. Fax: 020 7582 5900 Health Unlimited provides help

to indigenous people in Brazil, Burma, Cambodia, China, El Salvador, Guatemala, Laos, Namibia, Nicaragua, Peru and Somalia. Most of their work is of a public health nature, promoting disease prevention by work-ing with local people and promotions such as radio campaigns. For these reasons, public health rather than clinical specialists are usually recruited. Contracts are usually for around 2 years and salary and fl ights are paid. Vacancies can be found on their website, in the Guardian and the Inter-national Health Exchange Magazine.

Health Volunteers Overseas www.hvousa.org PO Box 65157, Washington DC 20035-5157 USA. Tel: +1 202 296 0928. Fax: +1 202 296 8018. HVO provides volunteers

to teach health care in Africa, Asia, the Caribbean and South America. Anaesthetists, surgeons (especially max fax and orthopods), paediatricians, dentists and nurses are usually required. Note, the prinicipal of HVO is to teach rather than to actually provide health care. Most posts are for 2 – 4 weeks. Any nationality can apply, but expenses have to be covered by the volunteer themselves (usually around $3000 for a month).

HelpAge International www.helpage.org 67–74 Saf-fron Hill, London EC1N 8QX. Tel: 020 7404 7201. HelpAge supports disadvantaged older people in over

49 countries throughout Africa, Asia and South America. They run emer-gency programmes following disasters and confl icts.

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HMD Response International www.hm-dresponse.org 23 Pembridge Square, London W2 4DR. Tel: 020 7229 7447. Fax: 020 7229 3434. Response International has both paid

and volunteer work in areas of recent confl ict (Bosnia, Kosovo, Leba-non, Pakistan). Doctors (G.P.s), nurses and physiotherapists as well as those with public health skills are required.

Institute for Health Sector Development www.Ihsd.org , 27 Old Street, London EC1V 9HL. IHSD sends it’s own in-house consultants to advise on major projects overseas.

Institute for International Cooperation and Development (IICD) www.Iicd-volunteer.org PO Box 520, Williamstown, Massachusetts 01267,

USA. Tel: +1 413 458 9828. Fax: +1 413 258 3323. The IICD organises voluntary work in India, Africa and South America for periods of 6 -18 months. Volunteers have to pay a fee (usually between US$3-6000).

Interaction www.Interaction.org 1717 Massa-chusetts Ave. NW, Suite 701 Washington, DC 20036. Tel: +1 (202) 667-8227. Interaction is

an alliance of 160 US Non Governmental Organisations, which cover every developing country. Check out their website for details.

International Care and Relief www.icrcharity.com 27 Church Road Tunbridge Wells Kent TN1 1HT. Tel: 01892 519619. Fax: 01892 529029. ICR works in some of the worlds poorest areas to provide sanitation, basic needs and primary health care while teaching self-sustainability. International Child Care Trust Unit 3L, Leroy House, 436 Essex Road, London N1 3QP.

International Health Exchange www.ihe.org.uk e-mail [email protected] 134 Lower Marsh Road, London SE1 7AE. Tel: 020 7620 3333. Fax: 020 7620 2277. The IHE is a central organisation that helps recruit health pro-

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fessionals to many international organisations. It lists available jobs in its two magazines: The Health Exchange and Job Supplement and also on the web. It runs a number of courses for those planning to work overseas.

International Medical Corps www.Imcworld-wide.org (US Address - 11500 west Olympic Boul-evard, Suite 506, Los Angeles, CA 90064-1524.

Tel: +1 310 826 7800. Fax: +1 310 442 662. UK address - 3 Anselm Road, Hatch End, Pinner HA5 4LH. Tel: +44 208 428 4025. IMC is an American-based non-profi t-making organisation that provides medical and other staff in areas of war, disaster or long-standing poverty. They offer a good salary and cover costs.

International Nepal Fellowship www.inf.org.np (Nepal - Head Offi ce: PO Box 5, Pkohara, Nepal. Tel: 61 20111. Fax: 61 20430. UK Offi ce: 69 Wentworth Road, Harborne, Birmingham B17 9SS. Tel: 0121 427 8833. Fax: 0121 428 3110. The INF have many projects across Nepal, but areas of particular speciality include TB, leprosy, HIV and community health. They require a broad range of health professionals for both hospital and community based work. Volunteers have to pay expenses. Check their website for placement availability. (N.B. You should be a practising Christian to work with them).

International Rescue Committee www.theirc.org 122 East 42nd Street, 12th Floor, New York, NY 10168–1289, USA. Tel: +1 212 551 3000. Fax: +1 212 551 3180. The IRC is a non-profi t-making, non-sectarian organisation providing aid

for refugees around the world. Founded by Albert Einstien to aid those being opposed by war and violence, their current emphasis is on help-ing those in Afghanistan, although they have projects in 30 countries. They provide emergency medical and public health support. Interna-tional Rescue Corps www.intrescue.org 8 Kings Road, Grangemouth, Stirlingshire FK3 8HW Scotland. IRC is a frontline search and rescue organisation that has participated in rescue operations after a number of disasters in the UK and overseas.

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International Service www.Internationalservice.org.uk Suite 3a, Hunter House, 57 Goodramgate, York YO1 7FX. Tel: 01904 647799. Fax: 01904 652353. International Service takes doctors, nurses and other health pro-fessionals to a number of countires in South America, the Middle East and Africa to collaborate with local organisations. Missions are for 2 years minimum but fl ights, accommodation and an allowance are provided. International Voluntary Service Inc 1424 16th Street, NW Suite, 504, Washington DC, 20036, USA.

Interserve www.interserve.org 325 Kennington Park Road, London SE11 4QH. Tel: 020 7735 8227. Fax: 020 7587 5362. Interserve is a Christian organization

that send all kinds of professionals (doctors, nurses, dentists, accountants, teachers, engineers, etc) on both short and long-term missions to many countries in the developing world. Their webiste lists current vacancies.

Juan Ciudad ONGDC/ Herreros de Tejada nº 3. 28016. Madrid (Ma-drid). Mail: [email protected]. Web: www.juanciudad.org. (+0034) 913 874 483. Fax. 913 459 076

The Jerusalem Princes Basma Centre for Disabled Children PO Box 19764, Jerusalem 91197, Israel. Tel: +972 2 626 4536. Fax: +972 627 4449. info@basma-centre. The Princes

Basma Centre provides rehabilitation, hydro and physiotherapy for disa-bled children. Minimum stay of three months. A small “pocket money” sum is provided.

Latin Link www.latinlink.org 175 Tower Bridge Road, London SE1 2AB. Tel: 020 7939 9000. Fax: 020 7939 9015. Latin Link International Offi ce: Schloss-Schürstr. 12. CH-8409. Winterthur. Switzerland. Postal

address: P O Box 279. CH-8405. Winterthur. Switzerland. t: +41 52 202

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0884. f: +41 (0)52 232 3454. Latin Link works in Argentina, Bolivia, Bra-zil, Costa Rica, Ecuador, Nicaragua and Peru. It performs both medical and community development work and takes doctors, nurses and medi-cal students (on electives). All must be committed Christians and ideally speak Spanish or Portuguese (depending on destination). Most work is for a minimum of three years though there are some short contracts of 1-2 years.

LEPRA www.lepra.org.uk Faifax House, Causton House, Colchester CO1 1PU. LEPRA works in a number of countries including India,

Nepal, China, Brazil and Madagascar to try to eliminate Leprosy. They are interested in hearing from any medical volunteers.

Leprosy Mission www.leprosymission.org Inter-

national Offi ce - 80 Windmill Road, Middlesex TW8 0QH. Tel: 020 8569 7292. Fax: 020 85697808. UK Offi ce - Goldhay Way, Orton Gold-hay, Peterborough, PE2 5GZ. Tel: 01733 370505. Fax: 01733 370960. The Leprosy Mission is a Christian organisation that works in over 30 countries throughout Africa and Asia. Doctors, surgeons, occupational and physiotherapists are required. All must be at least two years post-qualifi cation and be committed, pracitising Christians (of a Protestant or Reformed denomination).

Friends of Ludhiana www.friend-sofl udhiana.org.uk 157 Waterloo Road, London SE1 8UU. Tel: 020 7928 1173.

This is the UK support centre for the Christian Medical College, Ludhi-ana, Punjab, India.

Marlborough Brandt Group www.mgb.org 1a London Road, Malborough Wiltshire SN8 1PH. Tel: 01672 514078. Fax: 01672 514922. This UK based charity has links with the village of Gunjur in Gambia, West Africa.

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Marie Stopes International www.mariestopes.org.uk 153–7 Cleveland Street, London W1P 5PG/Bruce Mackay, 62 Grafton Way, London W1P 5LD. Tel: 020 7574 7423. - It is principally concerned with provid-ing reproductive and sexual health information in 38 countries. It also runs clinics in countries such as Kenya.

MEDAIR www.medair.org 13 Highfi eld Oval, Ambrose Lane, Harpenden AL5 4BX. Medair provides relief and rehabilitation to the most vulnerable; mostly women, children and the sick, in countries af-fected by war or natural disaster. They go to areas of greatest need, often very inaccessible areas. At the time of writing, such areas include Afrgh-anistan, Angola, Uganda, the Sudan, and Madagascar. They require doc-tors and nurses who are committed Christans for a minimum (usually) of one year. They provide fl ights and training and pay $100/month for the fi rst year increasing to $1000/month then on. Unlike many agencies, you only need to have one year post qualifi cation experience (you don’t need a PhD in public health etc). Vacancies are listed on their website.

Médecins du Monde UK www.medecinsdumonde.co.uk 29th Floor, One Canada Square London E14 5AA. Tel 020 7516 9103. [email protected]. Médecins du Monde needs medical workers for nearly 300 projects in 57 countries. They will take volunteers for as little as three months.

Médecins sans Frontières www.msf.org International Offi ce: Rue de la Tourelle 39, B-1040 Brussels, Belgium. Tel: 02 280 1881. Fax: 02 280 0173UK. Offi ce: 124–

132 Clerkenwell Road, London EC1R 5DL. Tel: 020 7713 5600. Fax: 020 7713 5004. US Offi ce: 6 East 39th Street, 8th Florr, New York, NY 10016 USA. Tel: +1 212 679 6800. Fax: +1 212 679 7016Canadian Offi ce: 720 Spadina Avenue, Suite 402, Toronto, Ontario M5S 2T9. Tel: +1 416 964 0619. Fax: +1 416 963 8707 Australian Offi ce: PO Box 847, Broadway, NSW 2007, Australia. Tel: 02 9552 4933. Fax: 02 9552 6539

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MSF is the world’s largest independent organization for emergency med-ical relief operating in over 80 countries where there have been either natural or man-made disasters. They want skilled medical and technical people over 25 for a minimum of nine months (although surgeons (who need to have 3 years of higher surgical training) and anaesthetists can get shorter posts of 6 weeks to 3 months in post-confl ict situations). Doctors need to be two years post registration and nurses two years post qualifi cation. G.P., Obs & Gynae, Paediatrics and tropical disesases (ide-ally the diploma) experience are very desirable. The cost to the volunteer is nil.

Medical Aid for Iraq, Unit 16, Foundation House, 38 Kingsland Road, London E2 EDQ.

Medical Aid for Palestinians (MAP), 33a Islington Park Street, Lon-don N1 1QB. Tel: 020 7226 4114. Fax: 020 7226 0880. Six month (and longer placements) mainly in the West Bank, Gaza Strip and the Leba-non, are given to experienced doctors and nurses to provide emergency relief and long term training. Flights, accommodation and a living allow-ance are provided.

Medical Education Fund. Mr Christopher John Robinson. Cathedral House. The Precincts. Canterbury. Kent. CT1 2EH. Tel: 01227 865282E-mail: [email protected]

Medical Emergency Relief International (MERLIN) www.merlin.org.uk 14 David

Mews, London W1M 1HW. Tel: 020 7487 2505. Fax: 020 7487 4042. Merlin provides emergency relief following a natual disaster, confl ict or epidemic regardless of religion or politics. They particularly target areas where the local health infrastructure has collapsed. They ideally stabilise the area over 6-12 months and then withdraw. You can register with them to be considered for work as a doctor/surgeon or nurse. A background in public health or tropical medicine is especially desirable. Contracts are for 6-12 months and an allowance is provided.

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Medical Missionaries for Marywww.medical-missionaries.com 66 Newland Street, Silvertown, London E16 2HN.

Médicos del MundoC/ Conde de Vilches, 15. 28028. Madrid (Madrid). Mail: [email protected]. Web: www.medi-cosdelmundo.org. Tlfno. 915 436 033. Fax. 915 437 923. Mercy Corps www.mercycorps.org In UK: 11 Grovelands

Avenue, Swindon, Wilts SN1 4ET. Tel: 01793 486 036. Fax: 01793 643 383. In US : 3015 SW First Ave, Portland, OR 97201. Tel: 800-292-3355. The website lists (mainly non-health-related) jobs around the world.

Mercy Ships programmes promote health and well-being by serving the urgent surgical needs of the forgotten poor and empowering developing com-munities. Mercy Ships are almost entirely staffed by volunteers from over 40 nations, who raise their own

fi nances to become crew members, paying towards the cost of living on board by way of monthly crew fees. It’s because of these charges that Mercy Ships is able to provide medical care and development as-sistance at an economic cost to the organisation and free of charge to recipients. Every year thousands of people volunteer their time with Mercy Ships on a short-term basis. Many of them return time and time again. Placements range from two weeks to one year on ships, land bases and support offi ces overseas. Mercy Ships UK. The Lighthouse. 12 Meadway Court. Stevenage, Hertfordshire. SG1 2EF.UK. Phone: 01438 727800. Fax: 01438 721900. Email: [email protected]. Mercy Ships USA. P.O. Box 2020 . Garden Valley . Texas 75771-2020 .USA . Tel: +1-903-939-7000 . Fax: +1-903-882-0336 . Email: [email protected]

Methodist Church Overseas Division Rev Winston Graham, Over-seas Division, 25 Marylebone Road, London NW1 5JR. Tel: 020 7486 5502. Fax: 020 7487 4042.

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Mid Africa Ministry www.midafricaministry.org - Partnership House, 157 Waterloo Road, London SE1 8UY. Tel: 020 7928 8681. Fax: 020 7401 2910.

Mines Advisory Group www.mag.org.uk 47 Newton Street, Manches-ter M1 1FT. Tel: +44 [0] 161 236 4311. Fax: +44 [0] 161 236 6244

Nepal Leprosy Trust www.rec.org.uk/nlt Address In Nepal: P.O.Box 96, Kathmandu, Nepal. In UK: 15 Duncan Road, Richmond, Surrey TW9 2JD. Tel: 0181 332 9023. Fax: 0181 948 2703. The NLT helps reha-bilitate those with leprosy and TB in western Terai, Nepal.

One World Action www.oneworldaction.org Bradley’s Close, White Lion Street, London NW1 9PF. Tel: + 44 (0)20 7833 4075. Fax: + 44 (0)20 7833 4102. This group works in Angola,

Bangladesh, Cape Verde, El Salvador, Guatemala, Honduras, Namibia, Nicaragua, the Philippines, South Africa and the Western Sahara. Ope-ration Crossroads Africa www.igc.org/oca 475 Riverside Drive, Suite 1366, New York, New York 10115, USA. Tel: +1 212 870 2106. Fax: +1 212 870 2644. Operation Crossroads Africa is geared to sending pre medical/nursing as well as medical and nursing students on community and medical projects in Brazil and twelve African countries. They also take qualifi ed volunteers to help training. There are usually around 10 volunteers per group and projects last 6 weeks. The projects are based in rural communities and run from mid-June to mid-August. Appli-cants should be between 17 and 35. There is a $3500 fee, but help with fundraising can be provided. There is a three-day orientation course in New York (compulsory).

Oxfam www.oxfam.org 274 Banbury Road, Ox-ford OX2 7DZ. Tel: 01865 311311. Fax: 01865 312380. They tend to only organise work in the country they are based, but may offer advice on work overseas.

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Pedro Cavadas FoundationDr. Pedro C. Cavadas has worked on Reconstructive Microsurgery in Spain since 1994. He developed the perforator fl aps known as

SS-PTP, M-SAP and BiFeP, among others. He and his team dedicate part of their valuable time helping others’ lives by performing complicated operations in undeveloped countries. Contact details: Clínica Cavadas. Paseo Facultades, 1, bajo 8 (Acc. por C/ Bernat Fenollar) 46021 Valencia SPAIN. Telf: +34 963628861. Fax: +34 963628870 Emergencias: +34 667246394. email: [email protected]

Plan International www.planinternational.org 5-6 Underhill Street, London NW1 7HS. Tel: 020 7482 9777. Fax: 020 7482 9778

Population Concern www.populationconcern.org.uk Studio 325, High-gate Studios, 53-79 Highgate Road, London NW5 1TL. Tel: +44 (0)870 770 2476. Fax: +44 (0)20 7267 6788

Project Hope www.projecthope.org HOPE’s Mission: To achieve sustainable ad-vances in health care around the world by

implementing health education programs and providing humanitarian assistance in areas of need. Project HOPE 255 Carter Hall Lane. Mill-wood, VA 22646. Email: [email protected]

Raleigh InternationalRaleigh International, Expedition Staff Offi ce, 207 Waterloo Road , London SE1 8XD. For further information or an informal visit please contact: Nicky Burwood Recruitment Executive on +44 (0) 20 7183 1270. Direct Dial: (0)20 7183 1291. Fax: (0)20 7504 8094 Raleigh In-ternational is one of the leading youth development charities in the UK. Raleigh International aims to inspire people from all backgrounds and nationalities to discover their full potential by working together on challenging environmental and community projects around the world. We send young people (aged 17 - 25) on three month expeditions to Ghana, Namibia, Fiji, Chile, Costa Rica & Nicaragua and Malaysian

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Borneo. A volunteer staff team (aged 25+) manages the young people. Volunteer Doctors, Nurses and Paramedics are a fundamental part of the staff team. The medic’s role on expedition is to help maintain the health and safety of all participants by teaching people the importance of preventative healthcare. In addition, medics have to be able to deal with emergency situations as well as a whole range of ailments from brucellosis, cellulitis, hypothermia to blisters, D&V and constipation! Whilst looking after the health of the group is the primary role, all nurses get to experience a Raleigh expedition fi rst hand, assisting in the construction of schools or health posts, or cooking for fi fteen people on a camp fi re! The Raleigh expedition has been described as the most intensive and constructive personal development experience available. You will develop a variety of new skills that will enhance you both personally and professionally. Many key skills learned are those looked for by employers: global awareness, leadership, teamwork, initiative, management, motivational skills.... to name but a few.

Red Cross Society www.redcross.org.uk (In USA: www.redcross.org) 9 Grosvernor Crescent, London SW1X 7EJ. Tel: 020 7235 5454. Fax: 0207 245 6315. The Red Cross, together with the Red Cresent provide professional vol-

unteers following natural disasters and confl icts. The headquarters are in Geneva (The International Committee of the Red Cross, 19 Avenue de la Paix, CH 1202, Geneva, Switzerland. Tel: +41 22 734 6001. Fax: +41 22 733 2057 Website www.icrc.org), but your fi rst point of contact should be the society in your country (Australian Red Cross – PO Box 100, East Melbourne Victoria 3002. Tel: 03 9418 5200. Fax: 03 9419 0404; New Zealand Red Cross – Red Cross House, 14 Hill Street, Wellington 1, PO Box 12-140, NZ. Tel: 04 472 3750. Fax: 04 473 0315, American Red Cross – Offi ce of the President, 17th and D Streets, Washington, DC 20006. Tel: 202 728 6600. Fax: 202 775 0733, Canadian Red Cross – 1800 Alta Vista Drive, Ottawa, Ontario K1G 4JG. Tel: 613 739 3000. Fax: 613 731 1411). The Red Cross provides professional aid to a number of countries. This can be short term after a disaster / confl ict, or more long term. Doctors and nurses with an acute surgical or anaesthetic skill are

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therefore required especially in confl ict or disaster situations. Primary Health Care skills are also important. They keep a register of potential volunteers. You must be between 25 and 50 for your fi rst secondment and registered with the GMC, if a doctor, or UKCC, if a nurse from the UK. Doctors need to be a registrar or consultant level and nurses should be at least 3 years post-qualifi cation. For community projects, a degree in public health or tropical medicine is often required. Flights, a local allow-ance and a salary are provided.

Rescue and Preparedness in Disasters (RAPID) www.rapidsar.org.uk “Beech Lodge”, Jacobstowe, Oke-hampton, Devon EX20 3RG. RAPID is an emergency response organisation that sends trained volunteers out to areas following confl icts and natural disasters.

Ryder Cheshire Foundation www.ry-dercheshire.org.uk (for physiotherapists), Ryder-Cheshire, 82 Queen’s Road, Brighton

BN1 3XE. Tel: 01273 821056. Fax: 01273 821059

Salvation Army www.salvationarmy.org Health Services, 101 Queen Victoria Street, PO Box 249, London EC4 4EP. Tel: 020 7332 0101. Fax: 020 7236 4981. The salva-tion army has links with many mission hospitals around the world.

Sandy Gall’s Afghanistan Appeal www.sandygallsaf-

ghanistanappeal.org PO Box 145, Tonbridge, Kent TN11 8SA. This organisation helps with prosthetics, orthotics and physiotherapy in Af-ghanistan.

Save The Children Fund www.savethechildren.org.uk Leonie Lonton, 17 Grove Lane, Camberwell, London

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SE5 8RD. Tel: 020 7703 5400. Fax: 020 7703 2278. Save the Children encourages locals to work and rarely sends out volunteers. Only highly qualifi ed people are required.

Scottish Churches World Exchange www.worldexchange.org.uk. The World Exchange offers both short visits and longer term (1 year) exchanges all over the world.

World ExchangeSt. Colm’s International House. 23 Inverleith Terrace. Edinburgh EH3 5NS. Phone (0034) 0131 315 4444.

Skillshare International www.skillshare.org 126 New Walk, Leicester, LE1 7JA. Tel: 0116 254 1862. Fax: 0116 254 2614. Actrion Health has now merged with Skillshare. They send professional volunteers

to Botswana, India, Lesotho, Mozambique, Namibia, South Africa, Swaziland, and Tanzania to train local people in inexpensive, effective healthcare skills. They provide costs but you must be between 21–63, have skills and work for a minimum of six months. You have to have at least two years of post-qualifi cation experience, though not necessarily have previous overseas work experience. Applications from all health care professionals (including those as couples or with families) are wel-come. Note that you will be required to do some fund raising before you go. Accomodation, food and transport costs and a small monthly allowance are provided.

SAO Cambodia (formerly Southeast Asian Outreach) www.sao-cambodia.org SAO Cambo-dia, Bawtry Hall, Bawtry, Doncaster, DN10 6JH. Tel: 01302 714004. Fax: 01302 710027. SAO has

a number of development projects in Cambodia. Qualifi ed health care workers can apply for both short and long term missions.

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Tear Fund www.tearfund.org Anthea Fisher, 100 Church Road, Teddington, Middlesex TW11 8QR. Tel: 020 8977 9144. Fax: 020 8943 3594. The Tear-

fund works with Christian groups in over 90 countries on relief and de-velpoment projects. Community-based health professionals are required and a salary as well as travel costs is provided.

Terre des Hommes www.terrede-shommes.org The Terre des Hom-mes International Federation is a net-

work of eleven national organisations working for the rights of children and to promote equitable development without racial, religious, politi-cal, cultural or gender-based discrimination. Headquarters. 31 Chemin Franck Thomas. CH-1223 Cologny/Geneva. Switzerland. Phone +41 22 736 33 72. Fax +41 22 736 15 10. E-mail: [email protected]

Treatment Action Campaign (TAC) www.tac.org.za - 34 Main Road, Muizenberg 7945. Tel: +27 (21) 788 3507. Fax: +27 (21) 788 3726. TAC’s main objective is to cam-paign for greater access to HIV treatment for all South Africans by raising public awareness and understanding about issues surrounding the availability, affordability and

use of HIV treatments. In the UK there is a “Friends of ” group called Friends of TAC www.fotac.org

The Ockenden Venture www.ockenden.org.uk Constitution Hill, Woking, Surrey GU22 7UU. Tel: 01483 772012. Fax: 01483

750774. Ockenden works to promote self-reliance for refugees, displaced people, returnees and their host communities throughout the world.

The Tropical Health and Education Trust (THET) www.thet.org Professor Eldryd Parry, 24 Eversholt Street, London NW1 1AD, UK. Tel: 020 7679 8127/8/9. Fax 020 7679 8190. The Trust aims

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to relieve the disadvantages in healthcare training in poorer tropical countries and to promote health through collaboration in teaching and research. It has many links between UK and African Hospitals. Medical Staff from all disciplines (including, for example, laboratory technicians) are required to train up local people.

Trocaire www.trocaire.org 169 Booterstown Avenue, Blackrock, Co Dublin, Ireland. Tel: 353 1 288 5385. This is the Irish Catholic Agency for

World development. Trocaire provides support both to development and disaster relief projects.

Ugandan Society for Disabled Children 68 Adrian Road, Ab-bots Langley, Herts WD5 0AQ.

Tel. 01923 263102. Fax 01923 267838 Email: [email protected]

UNICEF UK www.unicef.org Africa House 64-78, Kingsway, WC2B 6NB, London, Uni-ted Kingdom. 55 Lincolns Inn Fields, London

WC2. Tel: 020 7405 5592. Fax: 020 7405.2332 (Geneva Headquarters: Palais des Nations, 1211 Genève 10, Switzerland. US Headquarters: UNICEF House 3 United Nations Plaza, New York, New York 10017 U.S.A.) Although Unicef does not send volunteers overseas directly, it does run the United Nations Volunteer programme (www.unv.org) . Ap-plications can be made online.

United Nations Association International Service (UNAIS) Stella Hobbs, Suite 3a, Hunt-er House, 57 Goodramgate, York YO1 2LS. Tel:

01904 647799. Fax: 01904 652 353. This group works with locally -managed initiatives in Bolivia, Brazil, Burkina Faso, Mali and the West Bank and Gaza Strip. Primary healthcare is a particular priority. You must be over 18; two years are usually required, but costs are covered.United Nations Volunteers (UNVs) www.unv.org Postfach 260 111,

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D-53153 Bonn, Germany. Tel: +49 228 815 2000. Fax: +49 228 815 2001 (send CVs however to United Nations Volunteers Offshore Process-ing Centre, PO Box 25711, 1311 Nicosia, Cyprus). UNVs are currently working in 150 countries, and many of them are doctors, nurses and midwives acting to help develop health services within communities. Seventy percent of UNVs are themselves from developing countries. The average length of an assignment is 2 years.

United Society for the Propagation of the Gospel (USPG). www.uspg.org.uk . +44 (0)20 7378 5678 voice. +44 (0)20 7378 5650

fax. 200 Great Dover Street. London SE1 4YB

Volunteer Missionary Movement www.vmmusa.org or www.iol.ie This ecumenical organization recruits and prepares volunteers for a number of skills in Africa (Uganda, Kenya, Tanzania, Zambia) and Cen-tral America (Guatemala). You must be over 24 and a commitment of two years is normally required. Volunteer Missionary Movement. 5980 West Loomis Road. Greendale, Wisconsin 53129. (414) 423-8660 - main. (414) 423-8964 - fax. Email: [email protected]

Voluntary Services Overseas (VSO) www.vso.org.uk 317 Putney Bridge Road, London SW15 2PN. Tel: 020 8780 7500. Fax: 020 8780 7207. VSO is the largest over-seas volunteer recruiting agency in the world and sends

professionals to Africa, Asia, the Pacifi c Islands, and Eastern Europe. Their website has a database of work available for pharmacists, doctors, dentists, midwives, nurses, health educators/administrators, radiogra-phers, dieticians, OTs, physios and speech therapists. You have to be two years post-qualifi cation. Most posts are of two years duration (though occasionally some as short as 3 months are available). Flights, accom-modation and a living allowance are provided.

Wateraid www.wateraid.org.uk Prince Consort House, 27–9 Albert Embankment, London SE1

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7UB. Tel: 020 7793 4500. Fax: 020 7793 4545. Although primarily in-volved with supply of water to areas in Asia and Africa, Wateraid also has a hygiene programme that requires health care workers. Placements are usually advertised in the Guardian and on their website.

Worldvision www.worldvison.org.uk World Vi-sion House, 599 Avebury Boulevard, Milton Key-nes MK9 3PG. Tel: 01908 841000. Fax: 01908

841001. Worldvision is a large Christian Organisation providing devel-opment and relief projects to over 100 countries.

Worldwide Evangelisation for Christ International www.wec-int.org Bulstrode, Oxford Road, Gerrards Cross, Bucks SL9 8SZ UK. Tel: 01753 884631. Fax: 01753 882470. WEC is an interdenominational organisation working in over 60 countries. Medical posts for doctors,

nurses, midwives and physiotherapists are available in the Middle East, Ghana, Chad, the Congo and Guinea Bissau.

World Exchange www.worldexchange.org.uk St Colm’s International House, Inverleith Terrace, Edinburgh EH3 5NS. Tel: 0131 315 4444. World exchange has information on exchanges (usually lasting a year) all over the world.

World Health Organization www.who.org Personnel Offi cer, Avenue Apia 20, 1211 Geneva 27, Switzerland.

World Service Enquiry www.wse.org.uk , 233 Bon Marché Centre, 241-251 Ferndale Road, London SW9 8BJ. Tel: 0870 770 3274. Fax: 0870 770 7991. This organization provides vocational

information both to Christians and non-Christians. They have informa-tion on voluntary and paid opportunities, requiring either short (from two weeks) or long-term commitment in aid, development and mission agencies. They cater for the skilled and unskilled over 18.

doctors survival guide. medical english working overseas

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